HomeMy WebLinkAboutMiscellaneous - 291 APPLETON STREET 4/30/2018 (2)rl)
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No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Check #
25881 Building Inspector
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINAT
PermitINIO: Date Received
Date Issued: IMPORTANT: Applicant must complete all items on this page
LOCATION QQ L41)
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
11 Addition
11 Two or more family
11 Industrial
11 Alteration
No. of units:
El Commercial
)('Repair, replacement
El Assessory Bldg
El Others:
0 Demolition
0 Other
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�^ I QESC.RIPTIONOf WORKTO EX PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name:
I U ITOTIT-23
ARCHITECT/ENGI NEER Phone:
Address:
Reg. No.
FEE SCHEDULE. BULDINGPERMIT:$12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTB ON $125.00 PER S.F.
Total Project Cost: $ 16X -Y-> F E E: 1+
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to theguarantyfund
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Plans Submitted Plans Waived D Certified Plot Plan
a
I
Building Department
The foftowing is a list of th� required forms to be filled out for the appropriate permit to be obtained.
I
Roofing, Siding, lnt�erior Rehabilitation Permits
Building Permit Application
L3 Workers Com' Affidavit
p,
• Photo Copy Of I H.I.C.And/OrC.S.L. Licenses
• Copy of Contract
• Floor Plan Or P, roposed Interior Work
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit� Application
Certified Surveyed Plot Plan
Workers CompMidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contra i ct
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
NOTE: All dumpster permits irequire sign off from Fire Department prior to issuance of Bldg Permit
New Construction (single and Two Family)
L, Building Permit Application
L, Certified Proposed Plot Plan
Lj Photo of H.I.C. And C.S.L. Licenses
Workers ComP Affidavit
Li Two Sets of Buil I ding Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calcul I ations (if Applicable)
Copy of Contract
Lj Mass check Energy Compliance Report
Li Engineering Affi�avits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special per mit 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 subm.fted with the building application
Doc: DOC.Building Permit Revised 2012
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 21 A —F and G min.$100-$1000 fine
NOTES and DATA — (For department use
El Notified for pickup - Date
Doc.Building Permit Revised 20 10
No
Plans Submitted Plans Waived Certified Plot Plan El Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer El
Tanning/Massage/B.ody Art E]
Swimming Pools
Well El
Tobacco Sales El
Food Packaging/Sales El
Private (septic tank, etc. 1:1
Permanent Dumpster on Site 11
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT 1-1
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATEAPPROVED
11
Reviewed on Siqnature
Reviewed
Sianature
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer ConneGtion/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Locatea ;R54 USqooa z>ireei
FIRE DEPARTMENT Temp Qumpster on site Y'es no
Ic
Located at -1 �4 Main Strdet
F re- b
COMMENTS
Oct 29 2012 11:03:13 EDT FROM: F2M/17620070456 MSG# 34100391-006-1 PAGE 003 OF 003
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CERTIFICATE OF LIABILITY INSURANCE R022 ) 1 ) 2
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOTAFFIRIVIXTIVELYOR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUINQ INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
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F)wcorrif icm(-m holdar i s ,I It ADD IT 10. N A L I N �LTR -5` 7"h"o" m t.jqt bp orld orSpel . I f SU BRO GATI ON 1 S, W Al V ED . St.] bio(A to
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cortificate holdor iri lieu of 8tich orldorwimorit(ss).
PROM/Cen CONTACT
NAMP
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EASTERN INSURANCE GROTJP LLC/PHS �j(iLq 1,
08-7059 P.(866)467-8-730 ?:(800)308-5459 + rNx 11, (8 6 6) 4 6 7 - 8 7 10 (A/C,,N0j: (800)308-545
AODRF.$�.71,
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JOHN ]BEARDSLEY DBA JB PRESERVATION I . N - SU . 11 .. F. . R . C . . . ....... . ............................... . ......... — ---------- — — ---------- ----- .. . . ......
CARPENTRY I . NS .. L J .. RER D I.
48B DAY STATE RD ......... . ..........
NORTH ANDOVER MA 01845 . . . . .. . ......... . ........... . ......... ......... .......... . . .
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THI 15 fO�-(7—F.rT�FY--rHA—T'74E-:.-POI.ICIE'-, OF IN,5LJRANCF LISTED BELOW HAV� BEEN 11,551-15.1) TO TH5 INSURED NAMED A13OVE FOR THE POLICY PET067-
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, -rERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RF'SPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCIAISION$ AND CONDITIONS Or $0('H ?(XICIFS, LIMIT5 SHOWN MAY HAVF f3r-FN FREDUCrl) C4Y PAID (LAIMS,
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E.1 OISFASE V.A EMPIX)YE.F.
E.L. OISFASE POLICY 0KA11"
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Those usi.ial to the Insured's Operations.
CERTIFICATE HOLDER rANrpi I ATinKi
�,` 1,9kJd-ZU1 U AL;UHL) CONPORATIC)IN, All rights reserved.
ACORD 25 (2010/05) The ACORD naine aild logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
OErORETHC EXPIRATION DATr; THERCOP, NOTICE WILL BE
North Andover Building Department
1600 OSGOOD ST
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AWHORIZeD ARPRESENIFATWE
NORTH ANDOVER, MA 01845
�,` 1,9kJd-ZU1 U AL;UHL) CONPORATIC)IN, All rights reserved.
ACORD 25 (2010/05) The ACORD naine aild logo are registered marks of ACORD
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, AM 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:.
City/State/Zip: e9A Phone #: Vq W Qt -7 -3
Are you an employer? Check the appropriate box:
El I am a employer with
4. F1 I am a general contractor and I
employees (fall and/or part-time).*
have hired the sub -contractors
I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. n New construction
7. El Remodeling
8. E] Demolition
9. Building addition
10. Electrical repairs or additions
11. Plumbing repairs or additions
12 Roof repairs
13T1 Other
kny applicant that checks box# l must also fill out the section below showing their workers' compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work- and then hire outside contractors must submit a new affidavit indicating such.
,ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
am an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andJo'b site
iformation.
Lsurance Company N
:)Iicy # or Self -ins. Lic. #:
)b Site Address:
Expiration Date:
City/State/Zip:
ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ae 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
up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
vestigations of the DIA for insurance coverage verification.
lo h ereby certify under the pains andpen altles ofperjury that the information provided above is true and correct
gnature:
\., Date:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit[License
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...eve ry person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal.of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy inforination (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
vised 5-26-05
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Hotmail Print Message
,'IC-ontract for Carpentry- 291 Appleton St. North Andover, MA
From: John obpcarpentry@hotmaii.com)
Sent: Fri 10/26/12 4:47 AM
To: scurtin@comcast.net
Cc: jbpcarpentry@hotmaii.com
Contract for Carpentry- 291 Appleton St. North Andover, MA
- Front Entry Roof
Client -
Sean and Sue Curtin
291 Appleton St.
North Andover, MA 01845
Contractor -
John Beardsley
JB Preservation Carpentry
9 Lowell St.
i Andover, MA 01810
CS# 88368
HIC# 146678
Cell# (978) 973-2854
- Repair Rotted Front Entry Roof
1) Demo Existing Roof down to framing and remove debris.
s-700
2) Framing- Replace framing as needed and install new roof sheathing
plywood ) $500-$900
add $400 To Frame New square roof
3) Install New Rubber Roof ( slight
Pitch to sides ) $1,200- $1,400
4) Install new Trim ( PVC Dentill Moulding, $400-$800
5) Install new Beadboard Ceiling on underside of Entryway. $800
PVC)
�_6_)_Tot &1.--� $.-4-,, 00 0 z�$74-71K 0
j Payment Schedule
ist Payment - $1,200 at start
2nd payment - $1,200 after framing is done, ready for rubber roof
Page 1 of 2
3rd payment- $1,200 after rubber roof is complete, fascia moulding complete
except any special ordered pcs
Final Payment of $400-$1,000
Balance at Completion - Ceiling and Final Trim completed
http://snl07w.sntIO7.mail.live.comlmaillPrintMessages.aspx?cpids=dd82bea2-lf62-1 1e2... 10/26/2012
sn�. 111�1�
Silo,
Hotinail Print Message
,4
Contract for Carpentry- 291 Appleton St. North Andover, MA
From: John Obpcarpentry@hotmaii.com)
Sent: Fri 10/26/12 4:47 AM
To: scurtin@comcast.net
Cc: jbpcarpentry@hotmaiI.com
Contract for Carpentry- 291 Appleton St. North Andover, MA
- Front Entry Roof
Client -
Sean and Sue Curtin
291 Appleton St.
North Andover, MA 01845
Contractor -
John Beardsley
JB Preservation Carpentry
9 Lowell St.
Andover, MA 01810
CS# 88368
HIC# 146678
Cell# (978) 973-2854
Repair Rotted Front Entry Roof
1) Demo Existing Roof down to framing and remove debris.
$700
2) Framing- Replace framing as needed and install new roof sheathing
plywood ) $500-$900
add $400 To Frame New square roof
3) Install New Rubber Roof ( slight
Pitch to sides ) $1,200- $1,400
4) Install new Trim ( PVC ) , Dentill Moulding, $400-$800
5) Install new Beadboard Ceiling on underside of Entryway. $800
( PVC)
$4-,,Q00--;�$4,-,-r6O 0
Payment Schedule
Ist Payment - $1,200 at start
2nd payment - $1,2.00 after framing is done, ready for rubber roof
Page 1 of 2
3rd payment- $1,200 after rubber roof is complete, fascia moulding complete
( except any special ordered pcs )
Final Payment of $400-$1,000
Balance at Completion - Ceiling and Final Trim completed
http://snl07w.sntIO7.mail.live.comlmaillPrintMessages.aspx?cpids=dd82bca2-lf62-1 1e2... 10/26/2012
Hottnail Print Message
Contractor will get building permit for the above work
t
Existing Round Posts to remain with existing masonry steps.
Approval of Contract and Payment Schedule :
A
V ILIJ�
Client Contractor
Date. Date
John Beardsley
Page 2 of 2
http:Hsnl 07w.sntl 07.mail.live.com/maii/PrintMessages.aspx?cpids=dd82bca2-1 f62-1 1 e2... 10/26/2012
9295
0
Date. ZAhzr...
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .........
has permission to perform
plumbing in the buildings of .....
......................
at .... .............. *. North Andover
,,Mass.
Fee. Lic. No. .
PLUMBING INSPE TOR
Check # z z- T--
74
MASSACHUSETTS UNIFORM "pLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER. MASSACHUSEITS
Building Location :A 1�
Owner
New 0. Renovation El. Replacement 0
VYYqrTTID�imo
Date A),
Pmmrt#
Amount
Plans Submitted Yes n No
(Print or typer)
Rtstalling Company Name
Check one: Certificate
Corp.
Partner.
Firm/Co.
Name of Licensed plumber: QZ:2a� 0 L2�
Insurance Coverage: Indicate the type of ins�nce coverage by checking U —aP]7—
Liability i . nsurance policy Er Other type of indemnity opriat, bo.: Bond
F1
Insurance L the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are tnx and accurate to the
best of my knowledge and that all Plumbing work and installations performed under permit Issued for this application will be in
compliance with all pertinent provisions of the MassachusMs State lumbing d pter 142 of the General Laws.
By: t� 61VI-L
Signature 57M—censeq
Title Type of Plumbing License
cityao,xm
1 APPROVED (OFFICE USE ONLY ricense INUMM Journeyman n
I
The Commonwealth ofMassachusetts
Department Of 1-ndustrial Accidents
Office Of ZnVestigations
..600 Washington Street
Boston, AM 02111
www-mass.gov1dia
Workers' COMPensation Insurance Affidavit:.BuUders/Contractors/Electricians/Plumbers
Applicant Information
Name (B,
Address:
City/State/Zip:
Phone #:
Type of project (required):
6. EINew construction
7. Z<emodeling
8 - [] Demolition
9. [_� Building addition
10.0 Electrical repairs or additions
ILEI Plumbing repairs or additions
12 -El Roof repairs
13.El Other
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new
�Contractors that check this box must attached at, additional sheet showing affidavit indicating such.
the name of the sub -contractors and their workers' cOmP. Policy information.
lam an employer that isproviding workers' compensation In'Surancefor MY employees. Below is thepolicy andjob site
informadon.
Insurance Compiny
Policy # or Self -ins. Lic. #:
Expiration Date:
Job Site Address:
City/State/Zip:
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 M-GL c. 152 can lead to the imposition of criminal penalties of a
fine, up to $1,500-00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this 'statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains andpenaldes ofperjuYy that the information provided above is true and correct
— 9,2
Official use only. Do not write in this areq, to be completed by city or town offIciaL
City or Town:
1'ermit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk
6. Other
Contact Person:
4. Electrical Inspector 5. Plumbin.- Inspector
Phone#:
Are you an employer? Check the appropriate boxi
1. 1 am a employer with
4. [11 am a general contractor and I
employees (full and/or part-time).*'
2. 1�ri am a Sole or
have hired the Sub -contractors
listed
proprietor partner-
on the attached sheet t
ship and have no employees
These sub�contractors have
working for me in any capacity.
workers' comp. insurane
[No workers' comp. insurance
5. El We are a corporation andeits
required.]
3. 1 am a homeowner doing all work
officers have exercised their
right of exemption per MGL
myself [No workers' cornp.
c. 152, § 1 (4), and we have no
insurance required.] t
employees. [No workers'
cOmP. insurance, required.]
*AMY BPPlicautthat check.- box #1 must also fill OLi the, onhelo 1-0— —1;_ Z..
Type of project (required):
6. EINew construction
7. Z<emodeling
8 - [] Demolition
9. [_� Building addition
10.0 Electrical repairs or additions
ILEI Plumbing repairs or additions
12 -El Roof repairs
13.El Other
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new
�Contractors that check this box must attached at, additional sheet showing affidavit indicating such.
the name of the sub -contractors and their workers' cOmP. Policy information.
lam an employer that isproviding workers' compensation In'Surancefor MY employees. Below is thepolicy andjob site
informadon.
Insurance Compiny
Policy # or Self -ins. Lic. #:
Expiration Date:
Job Site Address:
City/State/Zip:
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 M-GL c. 152 can lead to the imposition of criminal penalties of a
fine, up to $1,500-00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this 'statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains andpenaldes ofperjuYy that the information provided above is true and correct
— 9,2
Official use only. Do not write in this areq, to be completed by city or town offIciaL
City or Town:
1'ermit/License #
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk
6. Other
Contact Person:
4. Electrical Inspector 5. Plumbin.- Inspector
Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation' or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employe; or the
receiver or trustee of an individual, partnership, association or other legal entity, employing e mployees. However the
owner of a dwelling house having not more than three apart[nents and who resides therein, or the occupant of the
dwelling house of another who employs persons to do mainte3nance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.91
MGL chapter 152,'§25C(6) also states that "every state or 10cal licensing *agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of coimpliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work unU acceptable evidence of compliance with the 'insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub�coritractor(s) name(s), address(es) and phone number(s) along with their certificat6(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) withno employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be.advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be syure to sign and date the affidavit. The affidavit should
be- returned to the. city or town that the apph-ca'don for the pernait- or" license is being requested . , not the Dep-artmonit of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' -
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of , the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be -used as a reference -number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future perraits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license orpermit not related to any business. or commercial ventare
(i.e. a dog license or permit to burn.leaYes etc.) said person is NOT required to complete this affidavit.
The Office of Investigations wouldlike to thnnk you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonweal& of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. #: 617-727-49-00 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
vmmr.mass-gov/dia
Date ... MX�� .........
0
TOWN OF NORTH ANDOVER
I we* PERMIT FOR GAS INSTALLATION
This certifies that ...........
has permission for gas installation rm� /�ee—
Aler zp ... , ,
in the buildings of ..... .....................
at ..... 4.?1. .., I .... 'A�*
................. North Andover, Mass.
Fee.,A&P�� Lic. No.. /q?� 7.
GASINSPECTOR
Check #
. 8113
-a -
r:ivlrl 113=11
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
#
C ity/To wn:-,& MA. Date:-�/-- 3 Perml
. I =
"2j- -- �
Building Location: 2:/ _,Oj Owners Name:
C
Type of Occupancy: Commercial El Educational Ej Industrial E] Institutional 0 Residential
New: E] Alteration: Renovation: E] Replacement: F4--' Plans Submitted: Yes [] No
r:ivlrl 113=11
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 91-9-0 F1
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A.liability insurance policy El Other type of indemnity El Bond F1
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 Owners Agent owner I—] Agent El
By checking this tiox —E], I hereby certify that all of the details and information I have submitted (or entered) regarding this applicat—ion are tr . ue and
accurate to the best of rny Knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Type d License:
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By T be
Gas
Title Gas Fitter Signature of L1,6en S -ed PlurAer/Gas Fitter
W-Ma—ster
Cityri-own Eliourneyman
APPROVED (OFFICE USE ON Y El LP Installer License Number: . lzf 7
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SUB B§-M—T.
BASEMENT
15' FLOOR
2 N u FL �OR
_jR"
FLO—OR
4"' FLOOR
—FLOOR
F'
6"' FLOOR
—FLOOR
ff
Uff FLO—OR
Installing Company Name:
Check One Only Certificate #
El Corporation
Address:
�Cityaown:
State:
&I'd
0 Partnership
Business Tel:
c4i:n�p
-
&/, ";'
D-
Fax:
E]Firm/Company
Name of Licensed Plumber/Gas Fitter:C�.-ZL-'&—
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes 91-9-0 F1
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A.liability insurance policy El Other type of indemnity El Bond F1
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 Owners Agent owner I—] Agent El
By checking this tiox —E], I hereby certify that all of the details and information I have submitted (or entered) regarding this applicat—ion are tr . ue and
accurate to the best of rny Knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Type d License:
lu
u�
By T be
Gas
Title Gas Fitter Signature of L1,6en S -ed PlurAer/Gas Fitter
W-Ma—ster
Cityri-own Eliourneyman
APPROVED (OFFICE USE ON Y El LP Installer License Number: . lzf 7
14�
The Commonwealth ofMassachusetts
D2 Department of]ndustriqlAccldi�ts
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip:
��,Vhone M -9--7-r —
Are you an employer? Check the appropriate box: Type of project (required):
LEI I am a employer with 4. 0 1 am a general contractor and 1 6. El New construction
employees (full and/or part-time).* have hired the sub -contractors 7. El Remodel'ing
2.k I am a sole proprietor or partner- listed on the attached sheet T
ship and'have no employees These sub -contractors have 8. Demolition
working for me in any capacity. workers' comp. insurance. 9. Building addition
[No workers' comp. insurance 5. El We are a corporation and its 10.El Electrical repairs or additions
required.] officers have exercised their
3 -El I am a homeowner doing all work right of exemption per MGL ILEI Plumbing repairs or additions
myself. [No workers' comp. c. 152, § 1(4), and we have no 12.E] Roofrepairs
insurance required.] t employees. [No workers' MEJOther
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 ire doing all work and then hire outside contractors must submit a new 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 isproviding workers' compensation insurancefor my employees. Below is thepolicy andjoh, site
information.
Insurance Company N
Policy # or Self -ins. Lic. #:.
Expiration Date:
Job Site Address: , City/State/Zip:
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certto under thepains Tdpenaltles ofperjury that the information provided above is true and correct
— — -//;/ - /) // - I C .
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License 9
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#:
M
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employeiis defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the coiiiinonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivi isions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that thei application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only subrnit one affidavit indicating current
policy information (if necessary) and under "Job Site Address"' the applicant should write "all locations in -(City or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is'on file for future permits or licenses. A new affidavit must be filled. out each
year. Where a home owner or citizen is obtaining a license or*permit not related to any business or commercial venture
(i.e. a dog license or p* ermit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
BostQn, MA 021 It
Tel. # 617-727-4900 oxt 406 or 1-877rMASSAFE
Fax # 617-727-7749
Revised 5-26-05
_WWW-mass,gov/dia
137 1 '121.
Date �� I.q. I .. 2 t ;�J/ -- �
0* V�ORTH 11 TOWN OF NORTH ANDOVER
4,
PERMIT FOR MECHANICAL INSTALLATION
c, L &A
This certifies that ........................................
has permission for mechanical instal .............
in the buildings of .....................
at C'q C/ .............. North Andover, Mass
Fee._.,12V.<':-� Lic. No.0.�'.� ... ............ .........
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. . PINK: Treasurer
Date: 51d /d 61 )
Estimated Job Cost: $
Commonwealth of Massachusetts
q06. 00
Plans Submitted: YES NO
Business License # (7
Sheet Metal Permit
Business Information:
Name: I e
Street: D ea t1f
City/Town: Ifie //06/SE7
Telephone: 79' f J Y I 7!q 13
Photo I.D. required / Copy of Photo I.D. attached
J-1 / M-1 -unrestricted license
Permit #
Permit Fee: $
Plans Reviewed: YES NO
Applicant License # (0 �,6_3
Property Owner / Job Location Information:
i
Name: J'�alj e�-j
Street: C-) � / /Z /V /-,/ S,� -
City/Town: /V1 1�1"VDOV
Telephone:
YES NO
Stafflnitial
J-2 / M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. / 2 -stories or less
Residential: 1-2 family Multi -family _ Condo / Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
HVAC Metal Wa tershed Roofing _ Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
.I/V&014L./( I -1Z a-/ 7 A_/ -�-VfL_ Iry I Oq C)( --e
,b.e UOQ�M
[INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes VNo r-1
If you have checked Yes i d
, in icate t e type of coverage by checking the appropriate box below:
A liability insurance policy 7 Other type of indemnity [] Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage req uired by Chapter 112 of the
Massachusetts General Laws, and that my signature on this p—ermit application waives this requirement.
Check One Only
Owner Agent
Signature of Owner or Owner's Agent
By checking this box Zj 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 sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES NO
Date
Date
By_
Title
City/Town
Permit
Fee $
Inspector Signature of Permit Approval
Progress Inspections
Comments
Final Inspection
Type of License:
M Master
El Master- Restricted
ElJourneyperson
oJourneyperson-Restricted
M
Comments
Signature of Licensee
License Number:
Check atwww.mass.cgiov/d I
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OFFICE NOTE,
NSPECTION REQUEST: ESCIFOOTING_(LUNDAT310N FRAME
ROUGH FINAL OTHER
orms inspections 2010 ml
DATE: (AV��5 CkPt-j !E�z
INSPEGTEb BY. --OF
DATE OF INSPECTION:
PASS FAIL OTHER
CORREdCTI NMl0WTffhll ECTIONCOMMENTS:
WME IN: TIME OUT:
INSPECTED BY'
DATE OF INSPECTION:
PASS FAIL OTHER
CORRECTION NOTE/ INSPECTION COMMENTS:
TIME OUT' .
IfISWTO BY.- VC�
DATE OF INSPECTION:
PASS . . FAIL OTHER
CORRECTION NOTE[ INSPECTION COMMENTS:
TIME OUT.
BY:
rA E OF INSPECTION:
PASS FAIL OTHER
CORRECTION NOTE[ INSPECTION COMMENTS:
TIME IN: TIME OUT, -
INSPECTED 13Y:
DATE OF INSPECTION. -
PASS FAIL OTHER
CORR!��NOTMTECTJON COMMENTS:
TikE.TIMEOUT.'—
I . .
INSPEGTIONS SERVIdS LOG
ADPRESS
PHONE
PERMIT# OFFICE NOTE:
INSPECTION REQUEST: ESCIFOOTING FOUNDATION FRAME
ROUGH FINAL OTHER
ADDRESS.
NAME
PHONE
PERMIT# OFFICE NOTE:—
lNsPEcTiON REQUEST: ESCIFOOTING FOUNDATION FRAME
ROUGH FINAL OTHER
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NAME
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PERMIT #
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NSPECTION REQUEST. ESCIFOOTING FOUNDATION FRAME
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=-RMIT 9 OFFICE NOTE:
SPECTION REQUEST: -ESC/FOOTING FOUNDATION FRAME
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UGH FINAL OTHER
Is InsPections 2010 rfil
DATE:'_� �l 2-1, Z -b i -z-
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41
TIME IN: TIME OUT: dAk-a- 11-2
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DATE OF INSPECTION:
PASS FAIL . OTHER I
CORRECTION Ef INSPECTION COMMENTS:
TI TIME OUT:
INSPECTED 13Y'
DATE OF. INSPECTION:
PASS FAIL OTHE�
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TIME IN: _ TIME OUT-
NSPECTED BY:
DATE OF INSPECTION:
PASS FAIL OTHER
CORRECTION NOTE/ INSPECTION COMMENTS:
TIME IN: _ TIME OUT.
INSPECTED BY:
DATE OF INSPECTION:
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CORRECTION NOTEI INSPECTION COMMENTS:
TIME IN: - - TIME OUT:
h-
INSPEGTIONS SERVICtS LOG DATE: M04 V,:q
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-,E DATE OF INSPECTION:
7 FAIL 'OTHER
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CORREdTION NOTE/ INSPECTION COMMENTS:
PERMIT# OFFICE NOTE:
INSPECTION REQUEST: ESCIFOOTING FOUNDATION FRAME
ROUGH FINAL OTHER TIME IN: TIME OUT:.
ADDRESS INSPECTED BY.
NAME DATE OF INSPECTION:
7A INSI
fji� DAT�
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io
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PE M
PERMIT 9 OFFICE NOTE:
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ON REQUE
INSPECTJ : ST.- ESCIFOOTiNO FOUNDATION FRAME
OTJ
(Zig�H FINAL OTHER TIME IN: TIME OUT:
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NA110m IDATE OF INSPECTION:
PASS FAIL OTHER
PERMIT # OFFICE NOTE: qORRECTION NOTEI INSPECTION COMMENTS:
INSPECTION REQUEST. ESC/FOOTfNG FOUNDATION FRAME
ROUGH FINAL- OTHER TIME IN: TIME OUT -
ADDRESS
NAME
PHONE
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NSPECTION REQUEST-: -ESCIFOOTING FOUNDATION FRAME
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SPECT[ON REQUEST: ESCIFOOTING FOUNDATION FRAME
-OLIGH FINAL OTHER
rrns InsPections 2010 rn!
NSPECTED 13Y.
DATE OF INSPECTION:
PASS FAIL OTHER
CORRECTION NOTE/ INSPECTION COMMENTS.
TIME IN:
TIME OUT:
INSPECTED BY.
DATE OF INSPECTION:
PASS FAIL OTHER
CORRECTION NOTE/ INSPECTION COMMENTS:
TIME IN: _ TIME OUT:
Location 0�'/ 4,4?41x�!�AJ
No. Date
Check #,�V96
25047
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $A�a
Foundation Permit Fee
Other Permit Fee
TOTAL
X17
//Building Inspector
Permit NO: 617 -12 -
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
I IMPORTANT: Applicant must comi)lete all items on this -oaRe I
/ 4A,61t
Print
MAP NO: -6-�PARCEL: ZONING DISTRICT:
ffistoric District yes (0
Machine Shop Village yes (9)
100year-old structure yes (9
TYPE -OF IMPROVEMENT
PROPOSEDUSE
Residential
Non- Residential
0 New Building
11 Addition
firAlteration
210ne family
11 Two or more family
No. of units:
11 Industrial
El Commercial
ErRepair, replacement
11 Demolition
0 Assessory Bldg
Other
D Others:
e 10,103 Men T �77,
Alf-. f-�V R��,A
-D
111 WEDIM! F91
�- -I rm: 011
da, 2",
MS
OF WORK TO BE PERFORMED:
I lklferrJ-, aIS7'
(Identification
OWNER: Name:
Type or Print Clearly)
?I -
Address:
CONTRACTOR Name: E& Q (4 -11�uyww Phone: 7 8- -74 0 tr
Address: vz�
Supervisor's Construction. License: / 1� -71 P/ ___)3xp. Date: 2 W -z-
Home Improvement License:
-f 2-4+ 3
Exp. Date: 9/3 Al� 7 --
ARCH ITECT/ENGI NEER Phon
Address:
. N
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $ e-11
Check No.: :z 0 .2 0 " Receipt No.: 'Z.5 0 V 7
NOTE: Persons contracting with unregistered contractors do not I
Wve ackes,� to tl
W,g u a (a n ty-)
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
• Building Permit Application
• Workers Comp Affidavit
• Photo Copy of H.I.C. And/Or C.S.L. Licenses
• Copy of Contract
• Floor Plan Or Proposed Interior Work
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition or Decks
• Building Permit Application
• Certified Surveyed.Plot Plan
• Workers Comp Affidavit
• Photo Copy of H.I.C. And C.S.L. Licenses
• Copy Of Contract
• Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Mass check Energy Compliance Report (if Applicable)
Li 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)
• Building Permit Application
• Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
Lj Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Ei Copy of Contract
• Mass check Energy Compliance Report
• Engineering Affidavits for Engineered products
NOTE:' 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
Imust be submitted with the building application
Doe: Doc.Building Permit Revised 2008mi
Dimension Total square feet of I floor area, based on Exterior dimensions.�
Number of Stories:...
Total land area, sq. ft.:
ement of Meter location, mast or service drop requires approval of
ELECTRICAL: Mov Yes ------------ —No—
Electrical Inspector
R ZONE LITERATURE: Yes No
t- 21A—F and G min.$10041000 fine
GL Chapter 166 ec ion
Doc:.Building ppnllit R,-vi,ed 2011 June/mi
11- -- -- --
Plans Submitted Plans Waived El Certified Plot Plan El Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer El Tanning/Massage/Body Art Swimming Pools
Well 11 Tobacco Sales El Food Packaging/Sales
Private (septic tank, etc. El permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT El" El
COMMENTS
CONSERVATION Reviewed on qianature
COMMENTS
HEALTH Reviewed on qicinature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comment
Cop.servation Decision: Commentz
Water & Sewer ConneGtion/ nrivpwRv P-'—;4'
DPW Town Engineer: Signature: Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on. site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
LI Designs, LLC Project: 291 Appleton Street- North Andover, MA 01845
cto Lisa- Pearce:
105 River Pointe Way Apt. 3112- Lawrence, MA 01843
Total Contract Price
$374,331.56
Tools
-$9,123.86
Decorative
-$34,953-.39
Electrical
-$25,450.00
Plumbing
-$7,2-00..00
$297,604.31
$ 3,571.20 permit
$ 7,142.40 doubled
(4,500.001 Payment received Z-Z77-IZ
2,642.40� Balance Due on Permit
This is a agreement between the town of North Andover & Ll Designs, LLC.
Ll Designs, LLC agrees tomake a second and final perynin fee payment as shown above,
by March 8,2012.
Signature
Signature Date -
Signature Date
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09/22/2011 13: 04 978-521-51.27 COSTELLO INS. PAGE 01/0117
ACORQ CERTIFICATE OF LIABILITY INSURANCE
Dom (mmelrewl
1 09/22/2011
THIS CERTIFICATE 111S ISSUED AS A MATTER OF INFORMATION ONL)' AND CONFERS NO PJGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWELY AMEND, EXTEND OR ALTER T,,t covERAGrE AFFORDED BY THE POLICIES
BELOW. 'THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTIA CONTRACT 015MEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCM AND THE CERTIFICATE HOLDER
IMPORTANT. It Ine cedmeam holcler is an ADDITIONAL 11;SURED, tfie must be enaorsed. it �UBWRWION 19 WAIVED. subje-�d to
the tanns and condWons of the policy, certain policies may require art endorsernem A statement on this certificate does not confer rights to the
certificate holder in lieu of �such endorsernent(s).
PrODUCER
.COSTELLO INSURMCE ACENCY
:2 South Kinball St.
i PO Box 5249
I Bradford, MA 02835
403L'T
PHONE
fAC. No. ft* 978. 374. 6352
INgURER(S) AFFORDING COVERAGE NAICA
National Gran9c Mutual 106. CO 14739
;iNamro Frank W�ia_rU _Carpentec-
512A Kain St
Soxford, MA �1921
Granite State Tns. to.-ARWC T3 10-2
INSURERC!
9NSIURER D;
mauRaR E
INSVRER F
I I wlvl��Jlm mumin�_mZ
11-TRT9!6 TO CERTIFY THAT THE POLICIES OF IN$UR&N�_E USTEOSELOW Fjk%A SEEN ISSUEDTOTHEiN-6URED NAMEDASOVIE- FOR TOE POLI&PEM05
IN13:10ATED. NOTWITHSTANDING ANY REOUIREMENIT, T LRM OR CONDITIO I CF: ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
ciftnrtwe mAy sE ISSUED OR MAY PERT NW, THE F4,QURANCE AFFORDID BY THE POUCiFS DESCRIBED WZPEIN 15 EUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SLX--H PouaES- LJmrrS SHOWN MAY �iAVE BEEN REDUCED BY PAID CI -MMS.
NCR
LTR
TYPE OF IW;UPANCE
POLIGY NUrADIR
I(
LIMITS
I
A
GaNERALLAGIL'TV
CCI6WERC4AL ejENERAL LIA91-TY'
_F 1 CLIUMS-MACEEX OCLVP
71
PIPM0078109112212011
109127J2012
0CCURRRIr.;_d 1,000,000
i 'RE1qTW__
jEiEs (Fa muffe"w S 500,000
NIM EeP (Any one oerswf) 5 10,000
—
PERSCNAL & ACW INiURY _L_ 1. 00A, 000
C EN ER AL AG G R GG ATE S 2,000,000
GENIL AGGP-EGATE LIMIT , A11PLIES PER:
J�L=
PROOL.C.-S - COW/OP AGQ S 2,000,000
A
AUTOMOBILE LLMI'.!YY
__7 NNY.W�D
AL, adVNEE) FV7 eCHEOLLFD
AVTO6 i - t AUTOS
X Fv7,�0N.0WNFZ
14'RG:) AUTGS ALITOO
11%10078�07110201i
10711AI2012
BOOILY INJURV (PC, pmm�) S
SOCILf INJORY (Fvac;6:ien�', S 500,000
100,000
UMBRELLA LtAB
MFS9 LIAS
EACH OCCURRENCE $
AGGREGATE
NORKER&COMFENGATION
AND EMPLOYERS'LIA13IL17Y
6,%-YPRCtPR00PJPARTNFRr4M =11'6
rXEC' ' I
OrFICM4AEMSER ex=LL0F_W
'mandwory in N"i
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ROV34 OF 02TRATIONS loe!oy
NIA
WC00994160
OW04/201110910
K I ikw-
T MT-iFT
E.L. EAC14 ACCIDIRSIT 5 100,00
E!I- OW -ASE - rmA -_V�LCYEE S 100,00o
S,L, 0j$I&ASE - R_sLCY LIMIT. 3 500.000
lww*ip-rioNcpopep,ArioN&ti,oc.A-mo-ist,iEmicLEs (AUBM ACDRO 1191, AWItIonal ftr4ft Schedulp- ItmDre space Is requirtd)
CERTIFICATE HOLDER
ACORD 26 (2010/05)
&tovw ANY OP The AWVE DE3011:590 FOLICIE0 CE CANCCLL#01) BEFORE
THE EXPIRATION QAT9 THERr;OF, NOTKA! MIJ- BE DELIVERED It,
ACCORDANCE WfTH THS POLICY PROVISIONS.
,it,; and lailo -ire registered marks of AGORD
All rights
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Total Contract Price $374.,331,56
Tools, -�9,123S6
Decorative -$34,953-39
Electrical -$25.,450.00
Piumbing, -$71200.00
$297,604-31
$ 3,571,20 permit
$ 7,142AG doubled
Date....
.............................
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
AC14US
Lzer7A-
Thiscertifies that ............................................... .... . ....................................
has permission to perform ..... r�,,TL /—/442. M. /Z.
wiring iwthe buil ing of ............... (—,.. ...................................................
..........
............. I ......................................... North. Andover, Mass.
Fee-� ...... Lic. No . ..... ...... .... . ...........
'ili RICAL-INSPECTOR
Check #
0749
,4
Commonwealth of Massachusetts
Department of Fire Service.4
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
-1
Permit No.
Occupancy and Fee Checked
'Aev. �/071
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR" K
All work to be performed in accordance with the Massachusetts Electrical Code CMR 12.00
(PLEA SE PAWT EV NK OR TYPB ALL XFORM TION) Date: / k
City or Town of. NORTH ANDOVER To the inspector of Wires:
By this application the undersigned gives notice o his or her intenfion to p6rform the electrical work described below.
Location (Street& Number) A511 /-,-- -, s— ge
Owner or Tenant CL
Owner's Address
Telephone No.
Is this permit In conjunction with a buildi permit? YescET--wo—O (Check App*roprlate Box)
r
Purpose of Building Utility Authorization No.
Existing Service Amps —Volts OverheadEl Undgrd 0 No; of Meters
NtwService
Amps —Volts OverheadEl Undgrd 0 No. of Meters
Number of Feeders and Ampacitj
Location and Nature of Proposed Electrical Work:
om 4 e C et -1K e
'No. of Recessed Luminaires
No. of Luminalre Outlets
No. of Luminaires
No. of Recept9cle Outlets
No. of Switches
No. of Ranges
No. of Waste Disposers
No. of Dishwashers
No. of Dryers
lo. of Cell.-Susp. (Paddle) Fans
lo. of Hot Tubs
wimming pool Above Ei In-
Ernd. gri
o. of Oil Burners
o. of Gas Burners
o. of Air Cond. Total
Heating XW
Heating Appliances KW
L.J ki t I— —
,ving table inay be waived by the Inspecto,
No. of Total
Transformers KVA
Generators KVA
INO .. of Emergency -Lighting
Battery Units
FIRE ALARMS INo. ofZones
No—.of Detection and
nitiating Devices
No. of Alerting Devices
El 1.'Lun"Plil El Otber
wwters I(W IiNu. Ul IN 0. 01 Data Wiring:
signs Baliasts I ?.T— — �. _.. _-__ —
I Telecommunications
No. of Motors Total HP 0Q.
IOTHER: I No. of Devices orEaulvalent
.," I — Attach additional detail ifilesired, or as regidred by the Inspector of Wires.
Estimated Value of Ejectrical Work: S (9 10- 0 Z> (When required by municipal policy.)
Workto Start: Inspections to be requested in accordance with NIEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation!' coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANC OTHER 0 (Specify:)
I cerqy, ufider th e!pfaa'n d I erju thattheinfi t'
&94 pena mina lor on thbuIpplication is true and cooplete.
FIRM NAME: J LIC.NO.:
-
Ci Signat-
Licensee_1:75:� ure LTC. NO.:
Wapplicable,-Enter 11 " ' th 1* number line)
e;�exe2m
p�g ie icens 9 ;-7 P:!G
4 �OAAe 0(�
Address: t) 4us. Tel. No.,
L_YLYLIAlt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Departmint ofAublic Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normallv
required by law. By my signature below, I hereby waive this requirement. I am the (check one) El owner El owner's aLe'nt.
Owner/Agent
Signature Telephone No._. ERMITEEE: $
_IP
kTMER GRODM )NSJ?VCTXO.N.-
kassad—f I
Ins _tors, c
pectors' comments.
Date
� PATE, CALLER —D NATIONAL. OR DO :
I?amecl — f I
)Cusvectbrsl Cawyneph:
Wed—
(lusp ectoral SigaRture - io
assed—F j
. coihments:
ygllell—
HAM:
Pate
Pate
1) 0 OR TAGIO AM TO BE FAUD OIJT AND LEFT ON 191TE -W THE APXA To BE WRECTED ISNOT
A AVn A Do
Y
The Commonwealth ofMassachusetts
Department ofIndustrialAccidints
Office of Investigations
600 Washington Street
Boston, MA 02111
UV www.mass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LedbIv
Name (Business/Organization/Individual): 0a
Address: V �P,
City/State/Zi L),(=,/- Ph,,, 4:
Are you an employer? Check the appropriate box:
1. El I am a employer with
4. El I am a general contractor and I
einployees (full and/or part-time).*
have hired the sub -contractors
LL�t� �Ole proprietor or partner-
listed on the attached sheet. I
ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. El I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1 (4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. E] New con struction
7. Remodeling
8. Demolition
9. E] Building addition
10.El Electrical repairs or additions
11. Plumbing repairs or additions
12. Roof repairs
13.Ei Other
!Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit 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.
Iam an employer that isproviding workers'compensadon insurancefor my employees. Below isthepollcy andjob site
information.
Insurance Company Name:.
;Policy # or Self -ins. Lic. M Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one�year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under thepains andpenaldes ofperjury that the information provided above,ts Yr eandcorrect.
Sian re: Date:
P— LP
P11 44. �q ) 6
Official use only. Do not write in this area, to he completed by city or town official
City or Town:
Permit/License
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "....every person in the service of another under any contract of hire,
express or implied, oral or written."
An employeris defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity� employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because'of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivi - sions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is ' required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit he affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permittlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one, affidavit indicating current
policy information (if necessary) and under "Job Site Address"' the applicant should write "all locations in ---(City or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is* on file for future permits or licenses. A new affidavit must be filleA out each
year. Where a home owner or citizen is obtaining a license or"permit not related to any business or commercial venture
(i.e. a dog license or p* ermit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachwetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston., MA 02111
Tel. # 617-727-4900 oxt 406 or 1-8777MASSAFE
Revised 5-26-05 Fax# 617-727-7749
--www-mass.gov/dia,
Date. . ..........
TOWN-'bF NORTH ANDOVER
X 'PERMIT FORGAS INSTALLATION
I '7SACH
SSACH 5
This certifies that ... -ne .....................
has permission for gas installation .2�p.
in the buildings of
at z 2 North Ando7 Imass.
Fee. 2kP?. Lic. No.. . .1f1k 40 . . ....... 14..
Check# //5�0 -3 GASINSPECTOR
8
BOARD
GF
TYPE
7 83 r4
A
INSURANCE COVERAGE:
I have a current liability nsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 6 No [I
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy [?9 Other type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement
Check One Only
Owner El Agent E]
Signature of Owner or Owner's Agent
By checking this box L]; I hereby corft that all of the details and information I have subinitted (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 pemit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts Plujing Code and Chapter 142 of the General Laws.
Type of License,
By Plumber
:91 Gas Fitter Of i r/Gas Fitter
Title U Master
City/Town []Journeyman License Number MG 3752
Anoofimin ifircipc imp nin vi D LP Installer
z -
MASSACHUSETTS UNIFORM APPUCA71ON FOR PERMIT TO DO GAS FITTING
CitylTown- North Andover I I MA. Date: 12/30/11 Permit#
Building Location: 291 Appleton Street — Owne;sName: Sean & Susan Curtin
Type of Occupancy: CommercialE] EducabonalE] IndustrialE] Institutional[] ResidentialM
New:E] Alteration:F1 Renovation:Ej Replacement:a PlansSubmitted: Yes[] WE]
INSURANCE COVERAGE:
I have a current liability nsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 6 No [I
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy [?9 Other type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement
Check One Only
Owner El Agent E]
Signature of Owner or Owner's Agent
By checking this box L]; I hereby corft that all of the details and information I have subinitted (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 pemit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts Plujing Code and Chapter 142 of the General Laws.
Type of License,
By Plumber
:91 Gas Fitter Of i r/Gas Fitter
Title U Master
City/Town []Journeyman License Number MG 3752
Anoofimin ifircipc imp nin vi D LP Installer
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Check One Only Certificate #
Installing Company Name:
AccuAire
Inc.
M
131 C
Corporation
Address: P-0-
Box 410
cityrrown:
Reading State:
MA.
[I
Partnership
Business Tel:
781 .944. 2211
Fax:978.664.4246
0
Finn/Company
Name of Licensed Plumber/Gas Fitter: Kenneth R-
Nielsen II
INSURANCE COVERAGE:
I have a current liability nsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes 6 No [I
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy [?9 Other type of indemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement
Check One Only
Owner El Agent E]
Signature of Owner or Owner's Agent
By checking this box L]; I hereby corft that all of the details and information I have subinitted (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 pemit issued for this application will be in
compliance with all Pertinent provision of the Massachusetts Plujing Code and Chapter 142 of the General Laws.
Type of License,
By Plumber
:91 Gas Fitter Of i r/Gas Fitter
Title U Master
City/Town []Journeyman License Number MG 3752
Anoofimin ifircipc imp nin vi D LP Installer
z -
0
Fold, Thpn Delach Along All Pnilr1t,-ilions
cOMMONWEALTH OF MASSACHUSETj
BOARD I . N - P RS IMPORTANT NOTICE
LUMBERS AND GASFITTEI
GF REGISTERED AS A GAS CORPORATIOW, PERMITS FOR PLUMBING AND GAS FITTING
ISSUES THE ABOVE LIC17FISE TO� INSTALLATIONS ON STATE OWNED OP USED
FACILITIES MUST BE FILED AT THE
OFFICE OF THE STATE BOARD.
TYPE KENNETH R NIELSEN 11
ACCUAIRE INC
PO BOX 410
MA 01867-0677
kEADING
81.5163 ()JjQj/JZ Ll 5 16
Fold. Tben nq!ach Alma Afl P-Inrallons
IMPORTANT NOTICE
BOARD
GF LICENSED AS A MASTER GASFITTER PERMITS FOR PLUMBING AND GAS FITTING
INSTALLATIONS ON STATE OWNED.CIR USED
FACILITIES MUST BE FILED AT THE
OFFICE OF THE STATE BOARD.
TYPE KENNETH R NIELSEN II
14 GRAND STREET
READING MA 01867-2c4l]
7 813 1 Z 3752 7 8 8 15 1
9345 Date.
- - - - - - - - TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .........
has permission to perform ........... lec- .......
plumbing in the buildir Of ........................
at ... 471- -/�� 4
..................... North Andover, Mass.
Fee,?P--��.Lic.NoJFVel. ......
PLL
I�BIIN UdOECTOR
Check #
&N
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
W'CITY
�151-;_
I MA DATE PE13MIT 9
JOBSITEADDRESS JOWNEWSNAME].
P
OWNERADDRESS TRO JFAXJ
TYPEOR
OCOUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL ,kl
PRINT
CLEARLY
NEW...A RENOVATION: 1 1 R�PLAGEMEWP PLANS 81.10MITTED: YES I N0,j I
FIXTURES -1 FLOOR—*
13SM
1
2
3
4
5
6
7
8
9 .
W
11
12
ll�
14
BATHTUB
j
7
. ...... —
�ROSS CONNECTION DEVICE
4
4'.
------ -- --
DEDICATED SPECIAL WASTE-GY4TEM
DEDICATED GASIOIL]SANDSYSTEM
J
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
A
DRINKING FOUNTAIN
FOOD DISPOSER
FLOORIAREADRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
_J
A
LAVATORY
ROOF DRAIN
6HOWER STALL
-4-
�EWCEIMOP SINK
T-,
TOILET
URINAL
WASHING MACIIINE CONNECTION
WATER HEATER ALL TYPES.
WATER PIPING
.OTHER I
INSURANCE - COVERAGE:
I have a ctirront. hs�iratjcepoliqor its st&tantial.equiValentwhich meds the lr�qqireniehts of MGLCh. 142. YESX NO
IFYOU CHECKEDYE$, PLEASE INDICATE TH.E TYeE OF COVERAGE BY C14ECKING THE APPROPRIATE 13OX BELOW
0ABILITYINSURAkEPOL(GY' OTHER TYPE OF INDEMNITY I 9OND
X1
OWNER'� INSURANCE.WAIVER: faill Arare ihat the licensee.dbes not have ihe'insurance coverage required by Chapter142 of the
MassachusettsGencral L awsaiidtliat-ii)ysigiiaturectitifispertiiitapplicatioli�,i �ivesllfisrequlre(lielit.
.01-ItCK-ONrONILY: OWNFRI I AGENTI-1
SIONATURL bFowNE RDR AGENT
I hereby certify that all of [fie details and Information I havatbb tledotdnlerediZ�gardin Als application aid true and accurate to the best of my knovilddge,
and that all plumbing work and in§lallations perform.ed under the peirnit Issued for this application Wit be in co iancievalhalipe'din P Sion 0 the
Massachusetts Mate Plumbing Code and Cliap;pr 142 of Hie General Laws.
PLUMBERt NAME jLICENS1E#I)/qW7, —
#De -6)2 tiioxe- WGRKTURT
MPI I jP CORPORATIONJ .111' IPARTNERSH P' 1111'
;kr i 1 .1 1 1 LLC 10 1
COMPANY NAME &r7jWj ADDRESS 1 6P12j-1j ljnPl7a I�WXel
CITY STATE ZIP e;M !ELI
FAX CELL ;�3 ) I EMAIL
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W111VAhass.gov/dIa
Date ...... 4:�.- . S . - .. / . ?— ....
.. ... .. .. ....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
11-00 -
This certifies that ................... R ... / .... ..... ...............
has permission to perform ..A.- /-�� .. / - 14-6. ��
.... ...............
wiring in the building of .............. C;��A..77 t,/ ...........................................
............
at 72k
................................................................. n.North Andovei, Mass.
Fee ... / .... Lic. NoAc�7,?3 .......
- /e
Check# 32 v
0 16 4.0
Commonwealth of Massachusetts Official Use Only
1 % Lin
Department of Fire Services Permit No. I
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
I[Rcv- 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perforined in accordance with the Massachusetts Electrical Code (MEQ, 5�7 CN�k 12.00
(PLFA SE PRflVT 1N)7VK OR YYPEA LL INFORM -4 TION) Date:
City or Town of. NORTH ANDOVER To the Inspector of Mires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 5�r—
Owner or Tenant 1114 V, Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes R Noqq (Check Appropriate Box)
Purpose of Building f11 -151t, Utility Authorization No.
Existing Service Amps Volts Overhead Undgrd No. of Meters
New Service Amps volts Overhead [:1 Undgrd [J No. of Meters
Number of Feeders and AmpacitY
Location and Nature o f Proposed Electrical Work: 14 -i; -t --2,
Al C -i4, -
Cnmnlptinn f)fth,, fnlInwi"a tnhlp mny ho w�ivad hi;Ma 1--mr rdWi—
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of 0i a - I
Transformers KVA
No. of Luminalre Outlets
No. of Hot Tubs -
Generators KVA
No. of Luminaires
Swimming Pool Above Ei In
grnd. grnd. El
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ���ARMS
No. of Zones
No. of Switches
No. of Gas Burners c)—
No. of Detection and
, Initiating Devices
No. of Ranges
No. of Air Cond. Total
.21— Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals: I
J.Nymb. e r]
Tons
..............
I KW
No. of Self -Contained
IDetection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Ei Municipal
Local Connection 0 Other
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
1��- Attach additional detail Y desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start21 - ,2 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE zP9--BONDE] OTHER [I (Specify:)
I certify, under thepains andpenalties ofperjury, that the information on this application is true and comp . lete.
FIRMNAME: 1111,yv4 14 /71,/-/,,, - Z� —LIC.NO.:
Licensee:- hla,4( A —Signatur LIC. NO.:
(If applicahle,,eqter "exempt " in the license num�ber line.) Bus.Tel.No.-. �Zrt
Address: - '// (--L J -,e- 1-/" ri-7, Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) El owner F1 owner's agent.
Owner/Agent
Signature Telephone No._ PERMIT FEE. $
FLECTMCAL MRAUT NO.
INSPECTIONREPORT.-
ELECTWCALINSPECTOP,
r3. UMER IG ROUM INSPY, CTION.
Passed — Re-luspection required ($60.00)
Inspeptor,
Inspectors' comments:
(Inspectors" Signatare - no Hjjajs) Date
DOOR TAGS ARE TO BE FILLED AND LEFT ON SITE IF TBE APXA TO BE INSPE CTED 18 NOT
ACCESSIBLE AND A RMNSPECTION OF 550.0 0 IS TO BE CHARGED.
The Commonwealth of Massachusetts
Department of Industrial Accid�nts
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip:
r,, ox A,, A 4 �-2 / d"o Phone#:
Are
,,you an employer? Checkrppropriate box:
1.19 1 am a employer with
4. El I am a general contractor and I
_
employees (full and/or part-time).*
have hired the sub -contractors
2.0 1 am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3.0 1 am a homeowner doing all work
right of exemption per MGL
myself [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required-]
Type of project (required):
6. r_� New construction
7. E] Remodeling
8. F-1 Demolition
9. F] Building addition
10?; Electrical repairs or additions
11. Plumbing repairs or additions
12.E] Roof repairs
13.n Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site
information.
Insurance Company Name:
y;'F
Policy # or Self -ins. Lic. Expiration Date:
Job Site Address:— City/State/Zip: An
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ce
thepain penalties ofperjury that the information provided above is true and correct.
Datw
-2�-( 17-1, J,,' -
Phone #: 7 ",_ y I �
Official use only. Do not write in this area, to be completed by city or town offilciaL
City or Town: PermithLicense #
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to . this statute, an employee is defmed as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer'is defiried as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shallnot because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'the affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in _(city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is'on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or -permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
Date .... In./P-11....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ... P?!�j ........
... .....................................
has permission to perform ... ..............................
4
wiring in the build' g of ........... ...............................................
at .... 4 ....... .. . North PAkandover, Mass.
... .. ...... 'n
F e e .... Lic. No..15.tP.� ............. .
PE
R -�PU
4EC�TMICALINS
Check # 3 e) -57
0582
Ae
0,
Date ..........
... .. ... ... .. ....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...
.......... ......................... ..... I ...........................
has permission to perform ...... 6-76-L ............ ......... 4,--eA3- .�6-5-.62
wiring in the building of ......... .......
at ...... .................. North Andover Mass.
Fee -M/37-:0-7497— Lic. No. J. ............
.... .. . . ........ ..... . ........
RICAL INSPE#OR
IV
Check# 017
10667
BOARD OF FIRE PREVENTION REGULATIONS
[(JJC,6 /
Official Use On]
Permit No.
Occupancy and Fee Checked
tev. 1/07] (leave blankl
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with tlie Massachusetts Electrical Code (MEC) MR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMA TION) Date: ///6
City or Town of- A)W44 4,, do tYJ2. r To the Inspector of Wires:
By this application the undersigned gives n6tice of his or her intention to perform the electrical work described below.
r
Location (Street & Number) Zy 4,4,0 /(- Y -d A -
Owner or Tenant -�SeAq CLfry-"A- - Telephone No.
Owner's Address 56L,(�.
Is this permit in conjunction with a building permit? Yes
Purpose of Building —110 e- 14
No El (Check Appropriate Box)
Utility Authorization No.
Existing Service Amps Volts Overhead 11
New Service Amps
Number of Feeders and Ampacity
Volts Overhead 1:1
UndgrdE:l
Undgrd 1:1
No. of Meters
No. of Meters
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
tuu- fftuy ut� wuiveu uy tne inspector ol wires.
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above 0 In
No. of Emergency Lighting
grnd. grnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches el
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranees
No. of Air Cond Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pu mp
...........
No. of Self -Contained
1
Totals:
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
iLoca, o Munic'PP' El Other
Connect
No. of Dryers
Heating Appliances KW
Security S ste s:*
-yst
No.
No. of Water
Heaters KW
No. of No. of '
of Devices or Equivalent
Data Wiring:
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunicatia
No. of Devices
OTHER:
Attacn additional detail Y desired, or as required by the Inspector of Wires.
Estimated Value ofElectrical Work: ?3'dd,64) (When required by municipal policy.)
Work to Start: ///0412 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCELTS�-�NDEI OTHERE] (Specify:)
I certify, under the pains andpenalties O�f ' ry, that,fhe #iLormation T n is true and complete.
an this a licatio
C
FIRM NAME:
LIC. NO.:-�A 9
Licensee:-Zalw1i �X dr, SignaturC7:,�,Z�, LIC. NO.,:,A 1'3 9
(I(applicablyter "?xenrl in the umber finee) - r
Address: S( -)JA J ry, Aor LA), Bus. Tel. No.:
Aft. Tel. No.:'
*Per M.G.L. c. 147, s. 57-6t,security work requires De�artment ofPublic Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally—
required by law. By my signature below, I hereby waive this requirement. I am the (check one� 0 owner [I owner's a t
Owner/Agent 12�
Signature Telephone No._
4
The Commonwealth of Massachusetts
------D'e-p-arthie'ni6fIiidi-is-t—riiiIAc-cident-s----
-0ff1c-e-qf-Investigations--_._
600 Washington Street
Boston, AM 02111
www.mass._aov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
of'.. � �r V A
Address:
4n /4
City/State/Zip 0 / LfCP'2_ Phone #:j )S- Ci� S` -Z
Are you an employer? Check the appropriate box: . . .
LEI I am a employer with
4. El I am a general contractor and I
employees (full and/or part-time).*
2)�� a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet. I
ship and have no employees
These sub -contractors have
working for me in any capacity,
workers' comp. insurance.
[No workers' comp. insurance
5. Weare a corporation and its
required.]
officers have exercised their
3. 1 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
A I:
comp. insurance required.]
ny app cam Mat CHCCKS DOXF] must also fill out the section below showing their workers' compensation policy information,
Homeowners who submit this affidavit indicating they are.doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurancefor my employees. Below is the policy andjob site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
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..
ove
I do hereby certify undrr the pains andpenallies ofperju that the information provided ab true and correct.
in
iper
Sig ature: 10F6 1/_1j
Phone#:
Official use only. Do not write in this area, to be completed by city or to wn 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#:
Enter construction cost for fee cal -
North Andover Fee Cakulation
Construction Cost
$: 4009:000.00
m
$ -
$
4,800.00
Plumbing Fee
$
600.00
Gas Fee 100 comm.
100.00
Electrical Fee
$
600.00
Total fees collected
$
6,100.00
291 Appleton st
LIDesigns, LLC
291 Appleton Street
PUNCHLIST
Michen-
1. Reset existing miciowam ttiM Mt
2. Adjust wood corner Ja--y Susan's
3. Sand out stain on wood butcher block and seal wlofl
a. Lisa millpick up oil fromfim
4. Adjust hinges and align door & drawer fronts on cabinetjy
S5. -Sypervise- Elm Park Flooring installation of carpet stair runner
a. 978-372-0050julic, orAmanda
b. 978-979-8427- Mark- Installer
Guest bath- Additional work reqziested
1. Install window treatment from Smith & Noble- Wood shutters
2 Disconnect existing sink& Faucet from Gianite top
3 Remove granite top – byr Select Stone
4. Confirin if client will he keeping andreplacing the exisHng tile splash orremoiing-*******
a. If *tile is remoivd
J. Patch- &repair 17?.Lffbo�—L4. paint. touch- UPS
thick
it. NewgTanite top to include a backsplash & side splashes 4"lugh x %
iii. Splashes need to be fipped to -1,41"for faucet hole clearance
iT,; See separate invoice for this project
5. Template & installgTanite countertop for replacement
a. Supen4se installadon ofnew stone 4v Select Stone Corp.
b. Reusing existing sink& faucet
i. -C21]Patiicia-wl�wyquestioi7s978-262-9a32
Family Room
1. Painting touchups
a. Second coat touch up required mer doorway and window casizigs
2 Crown -moldhng repairladjustment needed to Jeftside of TV
a. Frameless crown molding is pulling upon left bookcase
b. Check entire built-in for an�), additional adjustments
3. Caulk & seal around-ceilings-kylights
a. Yioubleshoot left sWight shade (it doesnot close all the way)
b. Repairas needed to adjust
Front Ent rylFoyer
L Reset bottom riser stair runner
a. Elm Park Flooring Warranty 978-979 8427 Mark- Installer
b. 7b be completed wlien kitchen stair runner is installed
Sean's Man Cave
1. Rer.-�e water dainr�ged ce&ngboard
a. Additional ceiling to be removed upon inspector request
b. Patch, repair, and finish new ceiiing board
i. LanyMaccarone781-771-1723
c. Re-insiafl ceiling beams removed for access
2. Insulate aroundfireplace insert to reduce aiFflow andpFeventpilotliombloTfing out
LIDesigns, LLC
978-314-9219
E-mail- 4LOgskogearfidink.net
3 -Review-mplacenientbeam options Tvithomiertoreplare tuistedtin.-beratfrontice-aterofFfmplare
H�dlway
1. Adjust escutcheon plate on chandelier so it will sitthish to ceiling
Front Craft Room _2,d Floor
I?c.-noi�-,-�,op&.ipejybookfror,.7-Toundtop-casij3g
a. Patch and touch up screu, holes
Master Bedroom/Closet
1. Un -install closet hutch on -Hghtlbathroorn urallfir access to central vacuum sv.stem
a. Connect loose vacuum and evaluate existing system
b. Troubleshoot entire system and make operational
2. Re-instail closet hutch
3. Patch, repair, touch up paint as needed
4. Replace missing Tvindow giille
Master Bathroom
1. Plasterlskim coat walls to smooth out rough finishes left by others
2. Patch & repair holes left by relocating fan and ad&ng new heat vents
3. Re -Paint walls and ceilings
4. Installnew cabinet trim moldfng on open linen shelves-Mateiial scheduled to arrive 1�1 week of February
5. Assess Amocking noise in 111 Boor wall when shower is running
-1. Open wallasneeded.10 strap down any w.-terhnes ca-s-ing thc.noisc
b. Patch, repair, paint wal/board as needed
6. Confitin showerpati, walls, etc. are water fight
a. Caulk and seal tile& stone as needed to prevent addidonal water damage to ceiling below
7. Repairpipe below vanii�� where lag screw from belowpunctured, to prevent future leakl�--
8. Troubleshoot entire sbower sp-stem by- turning on all valves at full and assess completely
b. Plumber, Anthonvf;om Tewksbury Plumbing& heaung-.508-972-0096
i Xoic* Hplumbingirispecior requires finishedspaces to be opened, Tewksbaryplumbing&
heating mill assume Financial responsibi6ty for aff workrelated to refinishing the space
ii, LIDesigns nillassume responsibility for the ceilings below
Pocket Doors (2hd floor bath entry & linen, Master bath)
1. Installpocket door guides on allpocket doors to prevent rubbing andg-ouging
2 Repair 2ny existing damage iointerior doors
a. Pai-it doors as needed after repairs
Exterior
I. Replace existing alurrilizzin.-flashing along house "'th galvanizedflashing
a. Remom.-ind replace existinff deck boards as -needed
2 Repair existing deck moldings
,a. Glue& nail 91picture frame mol&ngs-,remove andreplace as necessmy to ensure no future loosening
of moldings
b. Confirm finalfinish and seal coat is completed, if nec&ng one more coat, apply
3. Exterior frontpordca ceiling is leaking
a. 47ssess,'eaks andrecoatflat roof andflash, asneeded
b. Jusiallrain diver rers to keep water from runrung dovvn the siang
4. lusiallexteffor light bulbs as needed to replice others
Wood Flooring & carpefing
L Any and all issues surrounding hardwood finishes or wall to wall carpeting is fully warranted by
a. E)m Park Flooring 978-372-0050 showroom
b. JVote:hatdwaodI7Ooiiiig was stiinediu sonic cases a-adjustre-ii-nished-diroughout the ]ionic
i. Master closer floor receiTednew woodflooring
LI Designs, LLC
978-314-9219
E-mail- 4W�g�earthlink.net
Ekcaical
1. Permittitig for all elecuical workperforniedpast andpresent
2. Walk through with client to rewew 91switching, J-w;�T,suitching, etc.
J. Replace bulbs as needed to ensure appropriate i-olts and wattage have been used
4 Replace receptacle screws in fatchen with longer ones
a. Note: one has snapped off
Plumbing/ Gas
L Permitting forplumbing &gas work
2. Update and correct aj�vgas orplumbing lines required orrequested by the Town of North Andover
HVAC
L. Facilitate work required to enclose duct orrelated work byAccu,4ire
a. Xen Niclson781-944-2211
Gas & Plumbing- Tewksbury Plumbing & lleating� Anthony SaJipame- 908-972-0096
Electfical- Thomas Darragh
Aud(o/Video- Nexsense- Pau1jung-
Plasteiing & patch repair- LanyMaccarone-
Painting� Paul Luongo-
Tile installavon-SM-phen Dclazwy� TewAsburj, Tile &- iWasonT
Northbridge Glass cornpaqj- Banyshowergljv5
New England Reflnishing- Ed Gillen (kitchen cabinet reflaishing)
HVA C- Ne Tv wark by AccuAire Ken Melson
Carpenter,
License. -
Insurance:
Contactinfo.
781-799-0017
978-273-1462
781-771-1723
978-64,9-9649
978-866-2983
978-400-1310
978-962-3397
781-944-2211
LI Designs, LLC
978-314-9219
E-mail- LLOesigns(&,earthlink-net
99 '03
-�11-ql 0-070, --
Z71
lao,A
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6�a 'S
January 13, 2012
Met with 291 Appleton street designer, electrician, and new contractor/ helper. Jot basic information
about $ 400,000 remodeling job with no permit.
Attended J. Brown
B. Leathe
Peter Murphy
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Ll Designs, LLC
T LI UtNIUN�i, LLk-, DRAFT -2A
DESIGN AND PRE -CONSTRUCTION SERVICES
Client: Sean & Susan Curtin Site Visit: 04/19/11
Address: 291 Appleton Street Measure: 04/21/11
North Andover. MA 01845 Site Visit: 04/29/11
Email: scurtin(a-),nYcaP.rr.com 05/02/11
Sue: 518-727-3985
Z 1 9. '7'1'7 2 0 QA
-Y-f cr— / X. / —�' -� U �
-A - A Y - TT��
%JEINM�Pll� k-ViN.Ul I 1VINO (Notcs 1,61 Guncral Collud"01-1
Home is not occupied during construction- security is extremely important and should be
constantly monitored
House protection shall be maintained throughout the duration of the project to protect the
existing tloors, railings, walls, etc.
All trash and debris will be removed and disposed of as described
A dumpster shall be placed on site for project debris disposal.
a. Location to be determined by contractor so not to damage the existing driveway or
landscape
b.
Storage space for tools, materials and equipment will be garage bays
Job site cleanup will be broom swept at the end of each working day
Generat work hours wdl be Monday through Friday from 8 am to 5pm. (Weekends as
permitted and necessary)
All necessary permits will be provided by Andover Equity Builders and other trades as
required by North Andover & the state of Massachusetts
> All drawings shall be provided by LI Designs, LLC or LI Designs associates
a. Note: if additional engineering is required or requested, owner will be billed any
associated costs
1. Demo:
Kitchen
i. Demo and disposal of existing island cabinetry, countertops, refrigerator.,
dishwasher and tile flooring
ii. Demo & dispose of oak TV built-in in fireplacelbrick wall
iii. Demo & dispose of existing wood mantle and brick corbels only
1. Preserving brick facade
iv. Demo & dispose of tile backsplash
v. Demo and prep for new griddle to right of existing range
vi. Demo cabinet for larger exhaust fan
6 Tolland Road
North Andover, MA 01845
(978) 314-9219
vm,w.LlDESlGNS.net
2
Ll Designs, LLC
�, Upper Level Family Room
I . Remove existing carpeting and pad
1. Salvage carpet for Lisa"
ii. Disconnect and dispose of (2) ceiling fans
1. NOTE: Discuss possible repair vs. replacement of French door w/round
top- Re -install correctly'?*********
Mudroon-i/Garage Entry
i. No demo
Mudroom3/4Bath
i. Remove and dispose of pedestal sink, faucet, toilet, shower arrn & head, and
shower door
Dining Room
i . Remove and dispose of chandelier
11 . Remove & dispose of brass hardware on doors & windows throughout the house
Main Foyer
i. Demo & dispose of existing marble tile floor
ii. Remove and dispose of clear story chandelier light
Iii. Derno & dispose of existing carpet, stair runner
iv. Remove & dispose of existing front door
Living/Recreation room
i, Remove & disposal of existing painted mantle detail, tile facade and hearth
Master Bath
1. Demo & dispose of existing bath, shower, toilet, and vanity
I] Demo & dispose of existing wall mirrors, marble tile, lighting
Master Closet
i. Demo & salvage existing closet system for addition to existing bedroom closets or
basement utility
1. NOTE: Explore removal and relocation of pull down stair to
accommodate new closet design
Master Bedroom
i. Remove and dispose of existing ceiling fan
Guest Bedroom
J. Remove and disposal of tmistiAg bi-fold doors and sliding tracks
Molly's Bedroom
i. Remove and disposal of existing bi-fold doors and sliding tracks
Boy's Bedroom
i. Remove and disposal of existing bi-fold doors and sliding tracks
Second floor Full Bath w/Laundry
i. Denio & dispose of all eXisting fixtures, floor' , cabinetry
W&
1. Space to be redesigned for functional, separate use for bathroom and
laundry
Basement
i. Remove and dispose of existing sliding glass door
);o, Exterior
i. Removeand dispose of weathered, rotted, or decayed wood & trim including
columns on front entry
1. Brick stairs to be repaired by owners mason/landscaper
6 Tolland Road
North Andover, MA 01845
(978) 314-9219
wwwLIDESIGNS.net
3
Ll Designs, LLC
ii. Rear Decks
1. Remove handrails
iii. Remove other deck materials if replacement is required
iv. Electrical:
1. All decorative light sconces to be removed
2. Masonry
Kitchen
i. Chiraney n1spections as required for code
I i ing material for wood to gas conversion
11 Supply & install any chinmey lini
1. Gas insert spec:
2. Glass enclosure:
iii. Repair existing brick faOde & firebox as needed, using same or emulating used
brick to feather into existing
1. Note: Owner is flexible on changing the arch detail to accommodate
rectangular opening if required***see Lisa
iv. Clean and re -point all existing brick
v. Finish interior of existing wood storage area with V2? Bricks to match or emulate
existing exterior of fireplace
vi. Add new mantel TBD
vii.
Living/Recreation Room
I . Chimney inspections as required for code
i aterial for wood to gas conversion
n Supply & install any chininey lining in,
1. Gas insert Spec:
2. Glass Enclosure
ill . Supply & install rustic stone fa�ade per specifications to be attached.
1. Stone type: Fieldstone
2.
3.
3, Framing,:
Kitchen
i. Frame, as/if needed for new island design per specifications to be attached:
Upper Level Family Room
1. Frame if nee4ded for possible built-in for TV/prqjection
ii . Frame if needed for repair or replacement of French door
> Mudroom/Garage Entn, —N/A
> Mudroom 3/4 Bath N/A
> Duiling Room—N/A
Main Foyer
i . Provide and 'install new subfloor for marble tile
> Livig/Recreation room
i. Facilitate mason as needed for new hearth & fa�ade design
I I I I -i detail
11 Prepare ceiling to receive rustic false bean 1
6 Tolland Road
North Andover. MA 0 1845
(978) 314-9219
wwwLIDESIGNS.net
4 LI Designs, LLC
)�, Master Bath
i. Frame for new master bath design per plans provided'
I .
2.
Master Closet
j. Frame for new walk-in closet per plans provided
ii. Frame in and/or frame new attic, pull-down staircase TBD
Master Bedroom —N/A
Guest Bedroom- —N/A
Molly's Bedroom—N/A
Boy's Bedroom—N/A
Second floor Full Bath Nv/Laundry
i. Frame for new bath and laundry per plans to be attached
ii.
Basement
i. Frame for new sliding glass door as needed- replace all water decayed wood &
trim
1. SalvaRe door for Lisa & Jim
Exterior
i. Frame, as needed, for new colurrin and Portico repairs/replacements
4. Doors &Windows:
Kitchen ta,&� e
i. Repair & reset French doors- weather-strip 0 kt�
ii. Replace hardware with ORB finish
Upper Level Farmly Room
i . French door & round top repair
ii. Skylight repairs
iii.
Mudroom/Garage Entry —N/A
Mudroom '/4Bath
i.
Dining Room
Main Foyer
1 -1 1 hts vs. door only
i Entry door w/sidc ig
Livin&/Recreatlon room
Master Bath
i.
Master Closet
L
Master Bedroom
L
Guest Bedroom
6 Tolland Road
North Andover, MA 01845
(978) 314-9219
vimvIlDESIGNS.net
5
Ll Designs,, LLC
I. Closet doors- Hinged
a. Size'.
Molly's Bedroom
I. Closet doors- Hinged
a. Size:
Boy's Bedroom
I. Closet doors- Hinged
a. Size:
Second floor Full Bath w/Laundry
Basement
I. Exterior slidting glass door
Exterior
I. Front Entry Door
11 Size:
III Model,
iv. Brand & finish:
5. Flooring:
> Kitchen
I LI Designs to provide new Tile or alternate floor material
11 Install new tile floor, grout, and seal
Upper Level Family Room
I. LI Designs & Elm Park to provide new Carpet & pad
11 . Install new pad and carpet per specs attached
1. Type:
2. Color:
3. Details:
4. Border Color:
> Mudroon-dGarage Entry
I. Existing flooring to remain
1. Clean & repair ordy as necessary
2. Seal grout
)o Mudroom '/4Bath
I. Existing flooring to remain
1. Cleaa,,&
)o Dining Room
FEti&
1 Sand and refinish wood floori�j' no
I , W�m
Main Foyer
1, LI Designs to provide new marble floor tile 18x] 8 or equal
ii. Install, grout, and sealed by Elm Park Flooring
> Living/Recreation room
i. Sand and refinish wood flooring- Elm Park Flooring
Ii. ADD- New stained finish
(1) Color:
6 Tolland Road
North Andover, MA 01845
(978) 314-9219
www.UDE SIGNS. net
M
Ll Designs, LLC
(2)
Master Bath
1. LI Designs to provide new marble or porcelain tile
(1) See details and drawings to be attached
(2) Type:
(3) Color:
(4) Details:
Master Closet
1. Sand and -refinish wood flooring? Or replace carpet- Elm Park Flooring
)O� Mastfr
- -pearpoll
1. Sand and refinish wood flooring- Elm Park Flooring
m
11 Sand & ADD Ne,.v stained fi *sh
Guest Bedroom .
i., Sand and refinish wood flooring- Elm Park Flooring
Molly's Bedroom
L Sand anct refinish wood flooring- Elm Park Flooring
Boy's Bedroom
ii. Sand and refinish wood flooring- Elm Park Flooring
Second Aoor Full Bath w/Laundry
�i. LI Designs to provide new floor tile
ii. Install, grout and seal
Basement
1. Existing carpet to remai
>. Exterior
6. Electrical: decorative fivtures provided by LI Designs
i. All existing recessed lighting to have trim changed to standard white step baffle
ii. All new recessed can to be Lightoller 6" with white step baffle unless otherwise
noted below
ill. All receptacles, switches, and cover plates to be changed to biscuit color "Decora"
Style throughout the house
iv. All recessed can combinations to have dimmer style switches
V.
Kitchen
tv ighting for over new (up to 3
i . LI Designs to provide new decorati e 1i
separate fixtures is possible)
a. Model. -
11 . LI Designs to provide new center light fixture for table area
a. Model:
liL* Wire for new exhaust fan if needed
iv. Wire for new griddle to be installed to right of existing range**
6 Tolland Road
North Andover, MA O�1845
(978) 314-9219
www LIDE SIGNS. net
I
7 Ll Designs, LLC
v. Wire and install to new location
vi. TV Area:
a. New 42" TV to be mounted over the existing firebox
b.
C.
Upper Level Family Room
1. Replace existing celling fans and recessed can trims
I -note and hard switch
11 Ll Designs to provide (2) new Fan/Lights wlrej
Model
vi. Wire and *install dimmer for (2) New wall sconces
VIL LI Designs to provide (2) sconces
1. Model:
iii. Facilitate w-in*ng for Audio Video options to be discussed on site
> Mudroom/Ga:rage Entry
i. Keeping existing lighting- Clean out shades and replace
Mudroom3 4 _Rpth
i. Removing and replace existing Light fixture
ii . Provide, wire, and install one new Panasonic fan to a switch
1. Model: By electrician?
iii. LI Designs to provide new light fixture
1. Model:
> Dining Room
i. Wire and install dimmer for (2) New wall sconces
11 . LI Designs to provide (2) sconces
1. Model
In. Replace existing chandelier with new model provided by LI Designs, to a dirnmer
1. Model:
2.
3.
Main Foyer
i. Replace existing chandelier with new model provided by Ll Desigm., to a dimmer
11 . Install mechanical cable system to a switch located at base of stair
> Living/Recreation room
i. Wire and *install dirimier for (4) New wall sconces
1. Discuss locations at site visit
11 . Bar Design may require additional decorative lighting
1. Provide for (3) drop pendants to a dimmer
-counter refr'
Ill W're and install new under igerator
1. GE Beverage Center Provided by LI Designs
a. -Model:
iv. LI Designs to provide (4) sconces
1. Model
2.
v. Wire and install new pool table light to a diminer
6 Tolland Road
North Andover, NIA 0 184 5
(978) 314-9219
wwwLIDESIGNS.net
8 LI Designs, LLC
1. Model:
2.
vi, Provide, wire. and install up to (6) Recessed can to a dimmer switch
Master Bath: decorative fixtures provided by LI Designs
i. Wire and install up to (2) new vamity wall sconce
Master Closet
i. To be discussed on site
11,
Master Bedroom
L Replace existing ceiling fan/light
I Model:
> Guest-'-
%%dre
and install up to (4) newrecessed cans to a diimer/slvitch
> Molly's�Bedroorn
i. Trovide, N -Vire, and install up to (4) new recessed cans to a dimmer/switch
> Boy's -Bedroom
.i. Provide, 1,%qre, and install up to (4) new recessed cans to a dimmer/switch
> Second floorTuIl Bath iv/Laundry
1. Provide, v�ire, and instaU one new Panasonic fandight to a switch
ii. Wire and uilstall up to (2) vanity wall sconce
1. LI Designs to provide model:
2.
iii. Laundry area
1. Wire and install ceiling mount light to a switch
a. Model:
2. Provide wire and install one under -cabinet light to a switch
a. Model: by Electrician
> Basement
i. Lighting to be discussed with owner
1. Office Space plan not completed
Exterior
i. Disconnect existing and replace exterior wall mount sconces
i ii. ign
LI Des' s to provide (_) decorative fixtures to replace existing
1. Model:
2.
iii. Roofing/Heat tape options to be discussed to prevent ice damming
7. AUDIONIDEO/ALARM
General contractor to confirm existing alarm status and update existing hardware as
necessary or requested
Existing intercom system to be updated with the following possible options:
i. All intercom hardware upgraded to conternporary standards
ii. Suggest new whole house Audio options
6 Tolland Road
North Andover, MA 0 1845
(978) 314-9219
wwvv.LfDESlGNS.net
9 Ll Designs, LLC
1, System to have satellite radio and I -Pod capability
2.
3.
Television systems to be installed- Comcast will be the provider
I. Kitchen/Fireplace area- 42" TV
ii.. Living Room/Recreation Room- 42" TV
Ili. Family Room
I.—Discuss optional large screen wall TV w/surround soulid
2.. : Othen-vise- own-ers, existing 50" TV will be installed per plans by LI
- Designs
8. I-IVAC/Heating:
i. _$ijt.,*pect1on to confirm where decorative or wood vent covers should be used
m,,Iieu of existing brown, metal ones
)0, Kitchen
I. . -
> -Upper 1�py6l Family Room
:i. sible relocation on one heat and one return air vent for' new TV location
Entry
> Mudroom/413ath
> Dining Room
L
> Main Foyer
> Livilig/Recreation room
j.
Master Bath
i. See new Design/floor plan
Master Closet
I. See new Design/floor plan
> Master Bedroom
L
> Guest Bedroom
Molly's Bedroom
I.
Boy's Bedroom
L
Second floor Full Bath w/Laundry
6 Tolland Road
North Andover. MA 0 1845
(978) 314-9219
Ym,w.L1DESlGNS.net
10 Ll Designs, LLC
i. See new Design/floor plan
Basement
Exterior
9. Plumbing/Gas: Fixtures & appliances provided by LI Designs
> Kitchen
1. Disconnect existing sink, faucet, disposal, refrigerator line., and
dishwasher
11 . Reconnect new sink, faucet, disposal, and dishwasher
0 Under -mount Sink Model:
0 Faucet Model:
0 Dishwasher Model:
0 Refrigerator Model:
iii. Possible 2 d prep sink to be considered in new island design
0 S ink:
0 Faucet-,
iv. Install new gas line for gas griddle to be added to right of existing
range
Uppertcvel Family Room
> Mudroom/Garage Entry
> Mudroom3/4Bath
i. Disconnect existing toilet, pedestal, and showe�r- head
11 . Install LI,Designs supplied toilet, undermount sink, lav faucet, shower arm and
shower head
I . Toilet Model:
2. Sink Model:
3. Shower arm & head:
4. Lav Faucet:
5.
> Living/Recreation room
i. Option to run new bar sink and faucet
ii. Location to be verified
1. Sink Model:
2. Faucet Model:
Master Bath
i. Disconnect Toilet, sink, tub & shower,
11 . Run new waste, water, vent lines per new floor plan provided
1. Toilet Model:
2. Sink Model:
3. Multi -Valve Shower:
6 Tolland Road
North Andover, MA 01845
(978) 314-9219
Nvvm,.LIDESlGNS.net
P�� ,
Ll Designs, LLC
4. Lav Faucet:
5.
Second floor Full Bath w/Laundry
i. Disconnect Toilet, sink, tub & shower, washer & dryer,
11 . Run new waste, water, vent lines per new floor plan provided
I . Toilet Model:
2. Sink Model:
3. Shower & Tub:
4. Lav Faucet:
5. Washer & Dryer by Owner?
Exterior:
i. Test all exterior water spigots and shutoff valves
in.
iv.
10. Interior Finishes:
I I I in
LI Designs to provide separate list for window treatments ranging from bli ds to drapes &
curtains
)o, Stained and painted tnim:
i. Touch up all interior casnig, window stool caps, thresholds, staircase treads,
balusters, handrail, and baseboard as needed
-1
Wallboard & cel ings:
i. Patch and repair cracks, water damage, joints, and prepare for paint
as needed
> Repair & finish for skylights in cathedral ceiling 'in family room
interior and exten'or door & hardware to be changed to oil -rub bronze finishes unless
7 otherwise noted
I . Style: Lever
it. Add privacy locks to master craft/Storage room for Woman Cave
> Kitchen
1. Reconfigure existing cabinets to right of stove to receive griddle and
new exhaust fan
• Griddle Model:
• Exhaust Model:
ii. Island:
In. New Cabinetry, Countertops,
iv. Backsplash:
V. Refinishing existing oak cabinetry
• White wash fmish/country style
• Saniples must be provided for client approval
vi.
Upper Level Family Room
i. TV Storage &/or Built-in for stereo, gaming, receiver, etc.
6 Tolland Road
North Andover., MA 01845
(978) 314-9219
-vi-A,1A,.LlDES1GNS.net
r,
12 Ll Designs, LLC
PIN
ii. Finishes to emulate existing Pottery Bam storage pieces owner is
providing
Ing itu I
III Owner to provide pictures and/or list' of ffirin re pieces to be used
Mudroom/Garage Entry
i. Provide & install two-level coat hooks on right wall to accommodate child and
adult height hangdnv-
Mudroom 1/4Bath
I- New fixtures will be white
ii. New lav faucet and accessories to be brushed nickel or ORB
Note any new accessories needed after site visit:
2.
3.
4.
I 'Wainscot: Add wainscot molding to emulate decorative panel detail
---Walls: Smok), dark
_4i, Tfim: white ty
t"- � � , p.
Walls:
fi. Trim:
u. , Staircase:
1. New oriental type stair runner w/ hardware
2. New area rug to match or accent runner
tiving/Recreation room
i. Walls: Faux finish paint
ii. Simple rustic "beams" layout TBD
1. Stained to match flooring
ill. Stone f4ade w/wood mantel TBD
iv. Area rug for Pool Table
v. Pool Table: Option
vi. Area rug for sittmig area by owtier?
vil. Window treatments:
Vill.
Master Bath:
I. New wallboard to be skim coat blue -board with smooth finish
ii. Biscuit color fixtures w/ oil rubbed bronze faucet and accessories
iii. Cabmietry & granite countertop? TBD
1. Cabinet Brand: Elmwood
2. Granite:
3. Tile Floor and shower walls:
4.
6 Tolland Road
North Andover, MA 01845
(978) 314-9219
w,"-A,.LlD.ES1GNS. net
11777=i
7
13
Ll Designs, LLC
5.
6. Optional Seura TV for bath Mirror:
a. Model:
Master Closet
i. Wellborn Closet system- stained cherry or maple finish look w/accessories TBD
11 . Installation
Master Bedroom
i. Pam*t- Walls Faux?
ii. Stain new doors to match existmg-
> Guest Bedroom
i. Paint
ii- Stain, new doors to match existiqQ7
fii.
Molly's Bedroom
i. Paint
ii. Stain new doors to match em.'sting-
> Boy's Bedroom
ij- Stkiii-new doors to match em.'sting-
> Sei,-ojid-'fI6&TuII Bath w/Laundry
�..'Stainnew doors to match existing-
> Bas6m&nt
i. Paint
11 . Stain new doors to match existing
in.
> Exterior
i. Paint to touch up repairs
11. Painting: Colors and finishes TBD
6 Tolland Road
North Andover, MA 01845
(978) 314-9219
wmv.LIDESIGNS.iiet
Kitchen
i. size
Upper Level Family Room
I Size
Mudroom/Garage Entry
i. Size
ii. Size
Mudroorn 1/4Bath
1. Size
Dining Room
6 Tolland Road
North Andover, MA 01845
(978) 314-9219
wmv.LIDESIGNS.iiet
14 Ll Designs, LLC
> Guest Bedroom
i.-. size
> Motly's!Bedroorn
i. �ize:
> Boy's Bedroom
1. . Size
> Second -floor Full Bath w/Laundry
'i. S ize
> Basement
I. Size
> Exterior-
inisl:i Garage doors to match existing stain
th -New entry door to match garage doors
ver,�wrh and strip decks
ined to match existing garage doors
�Pards and new handrail to be stai
;v.pkhted faiishes
L Color: (white)
12. Insulation.-
)�- As required or needed
13. Exterior:
Repair water damage from Ice Damns
Install soffit vents and/or attic fan to improve attic circulation
i. Explore proper vent 'installation with minimal damage and remedy
Check entire exterior of house for trouble areas including windows, doors, decks,
foundation, supports, eaves, roof, etc.
14. Miscellaneous
Cleaning Service
i. All carpets, wood floors, windows, doors, etc.
6 Tolland Road
North Andover, MAO 1845
(978) 314-9219
www.LIDESIGNS.net
i. Size
M in
a' Foyer
I . Size
Living/Recreation room
i. Size
Master Bath
I. size
Master Closet
I. Size
Master Bedroom
I. S ize
> Guest Bedroom
i.-. size
> Motly's!Bedroorn
i. �ize:
> Boy's Bedroom
1. . Size
> Second -floor Full Bath w/Laundry
'i. S ize
> Basement
I. Size
> Exterior-
inisl:i Garage doors to match existing stain
th -New entry door to match garage doors
ver,�wrh and strip decks
ined to match existing garage doors
�Pards and new handrail to be stai
;v.pkhted faiishes
L Color: (white)
12. Insulation.-
)�- As required or needed
13. Exterior:
Repair water damage from Ice Damns
Install soffit vents and/or attic fan to improve attic circulation
i. Explore proper vent 'installation with minimal damage and remedy
Check entire exterior of house for trouble areas including windows, doors, decks,
foundation, supports, eaves, roof, etc.
14. Miscellaneous
Cleaning Service
i. All carpets, wood floors, windows, doors, etc.
6 Tolland Road
North Andover, MAO 1845
(978) 314-9219
www.LIDESIGNS.net
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BOARD OF FIRE PREVENTION REGULATIONS
P�ri�it No,
O-�&fp-a�yQdFpeC
'Rev.1/07]" 'I-,--.- �-,;
-Tleave bbilanl-V�,
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfornied in accordance with the Massachusetts Electrical Code (MEC) 5 7,CMR12.-00-,'
(PLEASE PRINTININK OR TYPEALL INFORMATION) Date:
City or Town of.
_ 1U61-44 1-7qdotye,r 16 the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Numl�e!)
Owner or Tenant .!S (?o
�q Curf t �y Tele hone
Owner's Address 56-L 4
r 0.
Is this permit in conjunction with a building permit? Yes El No [j (Check Appropriate Box)
Purpose of Building &e Utility Authorization No.
Existing Service Amps Volts OverheadEJ UndgrdEJ No. of Meters
New Service Amps Volts OverheadEl UndgrdE] No. of Meters
Aumber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
/I
No. of Recessed Luminaires
No. of Luminaire Outlet
No. of Luminaires
No. of Receptacle Outlets
No. of Switches
No. of Ranges
No. of Waste Disposers
No. of Dishwashers
No. of Dryers
go. of —Water
Heaters
5 W
No. of Cefl.-Susp. (Paddle) Fans
No. of Hot Tubs
Swimming Pool Above
grnd. El In- El
grnd.
No. of Oil Burners
No. of Gas B u-rners
No. of Air Co
Space/Area Heating K -W
Heating Appliances KW
KW ill 0. 01 No. of
— Signs Ballasts
No. Hydromassage Bathtubs
OTHER:
ta.ble may be waived by the J�g gecolo �Wie,-
0. or Total
Transformers K -VA
Generators KVA
0,. 0 mergency Ig ing
Batte Units
FIRE ALARMS No. of Zones
0. of Detection and
Initiating Devices
No. of Alerting Devices
No of Self-Containe F—
Detection/Alerti 1 Devices
Local r-1 Municipal
Connection El Other
Ke7urity System0E-
No. of Devices or E uivalent
Data Wiring:
No. of Devices or Eouivalent
No. of Motors Total HP Telecomn
I No. of
49- Attach additi I detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When requiroendaby municipal policy.)
Work to Start: Al Inspections to be requested in accordance with NIEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCELjeSjjjQ-ND E] OTHER 0 (Specify:)
1,cert�Vy, under thepains andpenalfles of rjujy,that e4RLO-n
-mation 'this a plicadon is true and complete.
LIC. NO.:
FIRM NAME: -x
J. C-
Licensee- f/14L J/ -e Signatur
(Vapplicable, te� 11 1 &— 6-� LIC. NO.: 139,) P
exe 'in the 11Z sl
? number linel)
Address: d oe &4J. (,41/ Bus. Tel. No.:
*Per M.G.L. c. 147 s Alt. Tel. No.:'
I - 57-61 'security Work requires Dep�artrnent o Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability i
r insurance coverage normally
Oquired by law. By my signature below, I hereby waive this requirement. I am the (check on El owner El owner's agent.
wner/Agent
Signature
Telephone No.
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lJDESIGNS, -LL C
CONTRACTOR: James Santos
DESIGNER:,
11saPearce
ADDRESS:
6TollandRd North Andover,,MA 01845
PHONE:
978-882-1708
FAX-
97-9-68-7-2302.
E-MAIL:
jdscontracting@earthlink.net
DATE: May 20, 2011
OWNEWSNAME- Sean-& Susan Curtin
ADDRESS: 291 Appleton Street
PROJECT ADDRESS: 291 Appleton Street- North Andover, MA 0 1845
1. PARTIES
Tlhis--wntract-�-hzreinafter Teferrzdto as, "Agreemenf ) is made mAvatuvd.intaou this 21st -day -af
May 2011, bly and betweenSean & Susan Curtin,, (hereinafter referred to as -ownee,)�- and Lisa
Pearce & James Santos, (hereinafter referred to as "Contractor"). In consideration of the mutual
promises, -,.contained her -em -4 Uontrzctor agrees to perfarm -the following *oxk, -subject to the lenns
and conditions below:
H. GENERAL SCOPE OF WORK DESCRIEPTION- Whole house remodel
See attached spread sheets
V (Additional Scope of Work page(s) attached: 15 Pages spreadsheets, floor plans,
A. LUMP SUM PRICE FOR ALL WORK A1BOVE* $
476000.—
This Agreen=t, wilt expire 15 days after the daW -at ft top. of page., one of th4 Agreement if If 4W
not accepted in writing by Owner and returned to Contractor within that time. '000;� elcl ve-
EL NOTES AND CLARIFICATIONS dl—allll
If any conflict should arise between the plans, specifications, addenda to plans, and this
Agrzement,-t,kxnAetmms,and-conditton-s of thisAgr=m, ent--shall-be.-contmIJing�md--binding�.-
upon the parties to this Agreement
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+L1 DESIGNS, LL C
CONMOING
III. GENERAL CONDITIONS FOR THE AGREEMENT ABOVE
A. EXCLUSIONS
This Agreement does not include labor and/or materials for the following work:
1. PROJECT -SPECIFIC EXCLUSIONS:
-a. Basemeuteaj:pet
b. Furniture & Window treatments
c. Landscaping & paving
4& -Faux.painting
e. ADT Security Contract
f. Anything not specified or contained in documents signed and reviewed as of
May. 2 l,, 2011
2. STANDARD EXCLUSIONS: Unless specifically included in the "General Scope of Work"
-section above, this Agreement does not include labor or nmterials for the following worlL PlaaS,
engineering fees, or governmental permits and fees of any kind. Additional work required by
governmental plan checkers on final "Red Lined" Job copy of plans that are yet to be issued.
Testing, removal and disposal of any materials containing asbestos (or any other hazardous
material as defined by the EPA). Custom milling of any wood for use -in project. Moving Ownees
property around the site. Labor or materials required repairing or replacing any Owner -supplied
materials. Repair of concealed underground utilities not located on prints or physically staked out
by Owner, which are damaged during construction. Fmal construction cleaning (Contractor will
leave site in "broom swept" condition). Landscaping and irrigation work of any kind. Temporary
sanitation, powei� or fencing. Correction of existing out -of -plumb or out -of -level conditions in
existing structure. Correction of -concealed substandard ffaming. Removat and replacement of
existing rot or insect infestation. Failure of surrounding part of existing structure, despite
Contractor's good faith efforts to minimize damage, such as plaster or drywall crackiiig and
popped nail's in adjacent rooms or -blockage of pipes or plumbing fixtures caused -by loosened rust
within pipes. Exact matching of existing finishes. Repair of damage to roadways, driveways, or
sidewalks that could occur when construction equipment and vehicles are being used in the
normal course of-constiucti6n. Cost ofcorrecting errors and omissions by the Owner's design
prof6ssionals, and' separate contractors. Cost of correcfmg/�testing/reme&iation old-Ifungus/mildew
and organic pathogens unless caused by the sole and active negligence of Contractor as a direct
result of a construction defect die caused sudden anitt significant water infiltration into a part of
the structure.
R. DA`I` E OF WORK CONUM[ENCEIVIENYAND SUBSTANTIAL COAff 9LETIOW
Commence work: May 23,2011.,Construction: time -through substantial-completiow-
Approximately 9 to 12 weeks, not including delays and adjustments for delays caused by:
--holidays-, inclemerit weatheer, accidents; shortage of laborormaterikls� addiThonal time requued
for Change Order and additional work; delays -caused by Owner,. Owner's design, professionals,
agents, and separate contractors; and other delays unavoidable or beyond the control of the
Contmetur.
n
LIDESIGNS, LLC J0
CONTIRMA-C
C. CHARGES FOR ADDITIONAL WORK: CONCEALED CONDITIONS, DEVIATION
FROM-SCADP-E 0F WORK, _AND,CHANGES IN THE WORK
1. CONCEALED CONDITIONS: This Agreement is based solely on the observations
to mmke withthe pirject -in -its �co ��* iatlh e time 9the Work --of this
Agreement was bid. If additional concealed conditions are discovered once work has commenced
or after this Agreement is executed which were not visible at the time this Agreement was bid,
,Contractor will-pointant-thest�concea4ed,,-On&ions�toow -and.t concealed.conditions
ner, hese,
will be treated as Additional Work under this Agreement. Contractor and Owner may execute a
Change Order for this Additional Work. Contractor is released, held harmless, and indemnified
-�y--O-vmer.fr-om-,-a4l-pre-�ex-istin.g�-m,o4d, fan_g_us,_mi_-1dew-,_and-_or gen
responsible for costs or damages associated with correcting, containing, testing, or remediation
the same.
2. DEVIATION FROM SCOPE OF WORK: Any alteration or deviation from the Scope of
Work referred to in this Agreement involving extra costs of materials or labor (including any
overaggeon ALLOWANCE work and any changes ta the Scope -of Work Tequined bY Owner,
Owner's design professional, Owner's agent, or governmental plan checkers or field building
inspectors) will be treated as Additional Work under this Agreement resulting in an additional
ch,arge to Owner -as set forth herein. Contractor and Owner may execute -a Change Order for this
Additional Work.
Contractor to supervise, coordinate, and charge 15% profit and overhead on the following: all
Additional Work -under -this Agrzement,, A ifiom,,, I
dditional _wwmk, vaused,by concealed_-zond-i -ai
overages on ALLOWANCE work, all Owner -furnished materials, and all work of Owner's
separate contractors who are working on site at same time as Contractor (any time in between
J, Contraztor he
when Contract�or__has-comm-encO workan- d wheri-4--hework-is 100%.1complete Y, T
Contractor will reasonably determine the amount of the Additional Work.
2a. Exceptions to the Contractor charging profit and overhead on Owner -supplied materials and
_G"er,s scparate.,coa�actq-rs -are stictly 4imited to -the -feWwing---
2b. Contractor's profit and overhead and any supervisory labor will not be credited back to
,owner with -anyd--ductiwChaiige-Orders�-wor-k -deleted fromAgreement -by �Owner�
D. PAYMENT SCHEDULE AND PAYMENT TERMS
1. PAYMENT SCHEDULE: 'e7eo.,000�—
* First Payment: or 30% of contract amount (whichever is less) due when Agreement
-is,signed and xetumedto Contractor: _$_
*Note- all materials require COD and special orders require 50-65% deposits
- All trades require individual deposits to get started
Third Payment:
Fourth Payment
LIDESIGN$ JDS
1,LLC CONTRA-CTING
Final Payment: Balance of contract amount due upon Substantial completion of all work under
V
-contrac
2. PAYMENT OF CHANGE ORDERS/ADDITIONAL WORK: Payment for Additional
W-Mik,is-Aue mpon. COT"ktionof-ewler A-Kor. pad- of be -Additio" Wo& and submittal �uf tnvoim
by Contractor,
3. ADDITIONAL PAYMENTS FOR ALLOWANCE WORK AND RELATED CREDITS:
-payment -
fmwork designated intheAgreeinent.as ALLOWANCE work -has been initiafly
factored into the Lump Sum Price and Payment Schedule set forth in this Agreement. If the final
amount of the ALLOWANCE work exceeds the line item ALLOWANCE amount in the
_Agreernent, t_hed1ff;2.
,Mnce�b�=�dw,fir.A�a�unt-md-theline-item,AU�OWANCEamount
stated in the Agreement will be treated as Additional Work and is subject to Contractor's profit
and overhead at the rate of 15%.
if the final amount of the ALLOWANCE work is less than the ALLOWANCE line item amount
listed in the Agreement, a credit will be issued to Owner after all billings related to this particular
Im AemALLOWANCE work.have been xeceived by Cot&nctor- This �credtt will be -applied
toward the final payment owing under the Agreement. Contractor profit and overhead and any
supervisory labor will not be credited back to Owner for ALLOWANCE work.
E. WARRANTY
Thank you for choosing Li Designs and JDS Contracting to perform this work for you. Your
satisfaction with our work is a high priority for us,, however, not all,possible coWlaints are
covered by our warranty. Material warrantees are strictly based solely on the manufacturers
warrantee. Contractor does provides a limited warranty against material defects on all Contractor -
and subcontractor -supplied laborand- materials used in. this -project for a -period of one-year
following substantial completion of a1l work. This warranty covers normal usage only. -You must
contact the Contractor at the address on page one of this Agreement in writing for warranty
service immediately upon discovering an item in.need of warranty service. If the matter is urgent,
you must also caTl . the Contractor and I send . written notice ofthe need for warranty service.-Fa-ilure
to notify the Contractor of the need for warranty service within ten days of discovery of a
hiririg of others. or direct actions. by
warranty item may void this warranty- Additionally,. Owner's
-Owner or Ownees separate contractors to repair a warrantyitcm are not covcrcd-by this warranty
andwill not be reimbursed by Contractor.
Contractor provides no warranty on any materials -filmi-shed"by the Owner f6rinst.01ation. No
warranty is provided on any existing materials that are moved and/or reinstalled by the Contractor
within the dwelling or the property (including any warranty that existing/used materials will not
"be damaged during the removal'andreinstallation processy. One year after substantidt"completion
of the project, the Owner's sale remedy (f6r materials and -labor) on aff materials, that are covered -
b
_y a manufacturer's warranty is strictly with the manufacturer, not with the Contractor.
Repair of the following items and relateddamages of every kind, are specifically excluded from
Contractor's warranty: problems caused by lack of Owner maintenance; problems caused by
Owner abuse,Owner-misuse, vandalism, Owner modification, orafttrafian-� and-uffmary�wear-
LIDESIGNS LLC
CONTRACTING
and tear. Damages resulting from mold, fungus, and other organic pathogens are excluded from
-this, warrantyunless-caused bythe� sole -and active -negligence,of zontractoras-a Airect vesultof -a
construction defect, which caused sudden and significant amounts of water infiltration into a part
of the structure. Deviations that arise such as the minor cracking of concrete, stucco, and plaster;
_mmorstvessAacUjFL_,_w -Arywall Aww he vmmg aAunbet� wmpih�gAud Jefleebon �Df wood;
shrinking/cracking of grouts and caulking; fading of paints and finishes exposed to sunlight are
all typical (not material) defects in construction, and are strictly excluded from Contractor's
waffz*_
insurance: Commercial Package- Zurich North America Small Business Policy
-APAS4469W8 978-657-5100
Local Agent: HUB IntematiO-nal New England
THE EXPRESS WARRANTIES CONTAINED HEREIN ARE IN LIEU OF ALL OTHER
WARRANTJES�,,EXPRESS-.0RJMPI"D, EWUJDJNG ANY WARRANTJES OF
MERCHANTABILITY, HABITABILITY, OR FITNESS FOR A PARTICULAR USE OR
PURPOSE. TIHS LIMITED WARRANTY EXCLUDES CONSEQUENTIAL,
INCIDENTAL, -AND SP�EC1AL J)AMAAGES -AND LIMITS TIM DURATION -OF
IMPLIED WARRANTIES TO THE FULLEST EXTENT PERMISSIBLE UNDER STATE
AND FEDERAL LAW. SOME STATES RESTRICT LIMITATIONS ON VARIOUS
WARRANTff,%t,,ANR,SOA. CONSUM�,SRJGHTS UNDER, WARRANTYMAY
VARY. THIS LIMITED WARRANTY MAY NOT BE VERBALLY MODIFIED BY ANY
PERSON. THIS LIMITED WARRANTY IS GOVERNED BY THE LAWS OF THE
_P
,STATE WHERE THE WORK WAS ERFORMED.
F. WORK STOPPAGE AND TERMINATION OF CONTRACT FOR DEFAULT
Contractor shall have the right, to- stop all- work on the project and. kee Job
ptheJ -idle ifpayments
are not made to Contractor strictly- in accordance with the Payment'Schedule in this Agreement,
or if Owner repeatedly fails or refuses to furnish Contractor with access to the job site and/or
Troduct selections or information -necessar
y for the advancement of Contractor's work -
'Simultaneous with stopping work on the proJect, the Contractor must give -owner written notice
of the nature of Owner's material breach of this Agreement and must also give the Owner a 14-
d4yperiod in which to cure this breach of contract. Owner to follow this. same, notice -procedure.
with Contractor if'Owner alleges -Contractor is in material breach ofthifs Agreement.
If work is stopped due to any of the above reasons (or for any other material breach of contract by
-Dv�) fbT a period -of -14 4ays, and -the Owner 4ws hiled to take significant ---,Wps lo--eurc his
def" then Contractor may, without prejudicing any other remedies Contractor may have, give
written notice of termination of the Agreement to Owner and demand payment for all completed
,wer-k-and-4naturiais-��4-hmugh,the-*ft--eUwor-k--stDppa --aT -
� Zq,,�Emd -
sustained by Contractor,. including -Contractor's Profit and Overhead at the rate of % on the
balance of the incomplete work under the Agreement. Thereafter, Contractor is relieved from all
-0 th" v omact uA Auties,4,ndudmg -all TAmch 4,ist and wam-=Ay -7� - -
G. DISPUTE RESOLUTION AND ATTORNEY'S FEES
A�wy Oan�versy W clatm ar4siqg�mftof or xelated- to4his AgTeement 4nvOW-mg�W-8mmnt Jess
than $5,000 (or the maximum limit of the Small Claims court) must be heard in the Small Claims
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Division of the Municipal Court in the county where the Contractor's office is located. Any
rt,arising!out�of this Agrzement- shall be
.,-d-i,,)uW -over 1hedollar Amit,of the�Small Claims Cou
submitted to an experienced private construction arbitrator that shall be mutually selected by the
parties to conduct a binding arbitration in accordance with the arbitration laws of the state where
1he proer TAe Arbiftator _4afl be �eidwx alwzused aftonwy -,or-Teuredjudge who 48
j A..isAocaWd-
familiar with construction law. If the parties can not mutually agree on an arbitrator within 30
days of written demand for arbitration, then either of the parties shall submit the dispute to
bin4ing-arbitration belore -the Anierican Arbitration: Association iRACCOW"ce with the
Construction Industry Rules of the American Arbitration Association then in effect. Judgment
upon the award may be entered in any Court having jurisdiction thereof.
The prevailing party in any legal proceeding related to this Agreement shall be entitled to
payment of reasonable attorney's fees, costs, and post -judgment interest at the legal rate.
H. FNTME AGREFMENT, SFVERABI[LITY, AND MODIEFICATION
This Agreement represents and contains the entire agreement and understanding between the
,parties-Ptior discussious, or verbal representations by Contractor or Owner that are not contained
si- W
-in this Agreement are not a part of this Agreement. -In the event that any proV1 on oft is
Agreement is at any time held- by a Court to be invalid or unenforceable, the parties agree that all
other greement will remain in full force and effect.. Aily future modification of
_provisions of this A
th7ts Agreement should be made -in writing and executed by Owner and -Contractor.
Contractor Arbitration s homeowners with the Tight-toinkiate -an
-The -Home Improw�m�
arbitration action (as an alternative to court action) if they have a dispute with a contractor. The
same right is not automatically afforded to a contractor, however. The contractor would have to
.resolveaq Amrvunlessboth Tarties, agree, to the optional..
y,dispute-he/she-has witli a4lomeowner mr
clause provided below- This clause would give the contractor the same riot to arbitration as is
afforded to the homeowner by the Home Improvement Contractor Law.
The,contacAor,and,theloulcowricr heiyab thatin the;ev= the
y mutually.1grep, in advance, It
contractor has a dispute concerning this contract, the contractor maysubmit the dispute to a
private arbitration firm that has been approved by the Secretary of I the Executive Office of
shall be req ired
comunwr Affairs and Business Regulation and theDonsunw � u
to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A.
.101- YL -1 Al
40 C1.11
NOTICE: The signatures of the parties above apply only to the agreement of the parties to,
-aittruativ,-;disput,-T,esWufioninifiat�ed,hythe,,L,mftactor- T-hehontoowner.,may.i.mtiat--.alteinativ,--
dispute resolution even where the parties do not separately sign this section.
Homeowner's Rights A bomeowner's rights under the Home Improvement Contractor Law (MGL
-cha� 142A) and -.other vmwnler VrOtect4011-laws, MGL zhapter 93A) 4nayaot -bewaived in
any way, even by agreement.
The contractor is responsible for completing the work as described, in a timely and workmanlike
xnanner- -aomeowaersmay be Pentitted lo ot�.specific -legal jights, ifthe zontrwtor guaranteesor
provides an express warranty for workmanship or materials. In addition to guarantees or
warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty
, . f
Z-1
JDS
+L1 DESIGNS5 LL C ro)WIMffING
of merchantability and fitness for a particular purpose. An enumeration of other matters on which
4he homeowner andumtractor Jawffilly agree may be Added to the,lermsof Ahe contractas long as
they do not restrict a homeowner's basic consumer rights. if you have questions about your
consumer/homeowner rights, contact the Consumer Information Hotline (listed below).
J. ADDITIONAL TERMS AND CONDITIONS
Subcontractors - The contractor agrees to be solely responsible for completion of the work
AeWXJbed regardless -of the acAofts of any third part utilized _y the
ylsubcoubwtOr A
contractor. The contractor further agrees to be solely responsible for all payments to all
subcontractors for materials and labor under this agreement.
-'See page(s) atta6hed- -yes -No
DO NOT SIGN IF THERE ARE ANY BLANK SPACES
J�havexead 4ind underswodwid J,agree -",the terms -and ms,�contained - 4-ni -the
Agreement above.
Three Da Right to Rescind
To cancel, you must notify the seller in writing, at the address given in the contract, by reg_War
mail posted, by telegram sent, or by delivery, no later than midnight of the third business day
kHowing1he signing -of theoontra& A_-bttsinns Jay under- t1is law includessny �calmdar-&y
except Sunday or holidays. Within 10 days of receiving your cancellation notice, the seller must
return your payment. You must allow the seller to pick up the goods at your address, or if the
P - h__em back at the selefs, expense -and risk - If -the
�ella requests, -and you ag-ee you may bip�t
,seller does not pick -up -the -goods -within 20,-day� of the, date -of thenotice �af cancellationthey, are
yours to do with as you wish.
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125 Date./ /
40RTH -1 TOWN OF NORTH ANDOVER
PERMIT FOR MECHANICAL INSTALLATION
This certifies that .14
has permission for mechanical installation DaeT
in the buildings of ......................
at C.p#-7 it�/( North Andover, Mass.
.......... ... . . .
4aFeI:3��.. Lic. No.. C� .......
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. . PINK: Treasurer
Fold, Then Detach Along All Perforations
�7 - - I - : - -1
-COMMONWEALTH OF MASSACHUSETTS.
BOARD
Zj."ht:T METAL WORKERS
Sm
-ASA MASTER -UNRESTRICTED:
ISSUES THE ABOVE LICENSE TO:
TYPE
KENNETH R NIELSEN II
mi
-1%4'.GRANEY STREET
-2411-
.:.READING MA 01867�
984667
-_7 318 - 11/28/12
Gm
Fold, Then Detach Along All Perforations
Commonwealth of Massachusetts
Sheet Metal Permit
Date: 12/30/11
Estimated Job Cost: $ 29, 338. 00
Plans Submitted: YES - NO X
Business License # 253
Business Information:
Name:. AccuAire Inc.
Permit #
Permit Fee:_$3Q--'G0
Plans Reviewed: YES NO X
Applicant License # 7318
Property Own r Job Location Information:
Name:
I
Street: P.O. Box 410 Street: 291 Appleton Street
City/Town: Reading, MA. City/Town: North Andover
Telephone: 781.944.2211 Telephone:
Photo I.D. required / Copy of Photo I.D. attached: YES NO X
J-1 / M- I -unrestricted license
Staff Initial
J-2 /. M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. 2 -stories or less
Residential: 1-2 family X Multi -family Condo Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. X over 10,000 sq. ft. Number of Stories: 2
Sheet metal work to be completed: New Work: Renovation: X
HVAC x Metal Watershed Roofing Kiichen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed description of work to be done:
We are removing the old duct board system and installing a new metal
dpct,system.
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes F] No E]
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policyEl Other type of indemnity El Bond E]
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner El , Agent F-1
Signature of Owner or Owners Agent
By checking this box[:], I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Date
Date
By _
Title
City/Town
Permit #
Fee $
Duct inspection required prior to insulation installation: YES NO
Inspector Signature of Permit Approval
Progress Inspections
Comments
Final Inspection
Comments
Type of License:
El Master
El Master -Restricted
[:1journeyperson Signature of Licensee
E]Journeyperson-Restricted License Number:
F-1
Check at www.mass.gov/dpl
&.1
Date.,:---/
3 55 7 2 ....................
TOWN OF NORTH ANDOVER
0 e.- PERMIT FOR GAS INSTALLATION
4
This certifies that ......
..............
_--!f 7
has permission for gas installation
in the buildings of ........
0—**—**—**---**—*
at .,j ........... North Andover, Mass.
�ic. No4-5.!O. e�
Fe�-� . . ......
Rt
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FO RMIT TO DO GASFITTING
(Print or Type)
r IV(v-74 -, mass. =e- 14 .1-9-06 Permit #
I
Building Location .2 91 AAAle 7 --CAI SZ, e e,7- owner's Name Q S4, A/
"P)c /Ps Type of Occupancy e
N ew C3 Renovation X Replacement 0 Plans Submitted: YesC] No []
Installing Company Name Boule Is Gas
Address 39 Oxford Avenue
Haverhill, MA 01835
Business Telephone 978-372-6783
Name of Licensed Plumber or Gas Fitter
Charles H. Boule"
Check one:
0 Corporation
0 Partnership
;a Firm/Co.
Certificate
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantlW equivalent which meets the requirements of MGL Ch. 142.
Yes Z No 0
If you have checked Yes, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy �ff Other type of indemnity 11 Bond C1
OWNER'S INSURANCE WAIVER: I am aware that the licensee.�Loes 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:
Owner0 Agent 0
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 i§;uedAor this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of
BY T of License:
Plumber Signiture of Licensed Plumber or Uas Fitter
Title Gasfitter
Master License Number J35��7
City/Town iliJiou f n eym an
Ap0FVyE0—MT 7ISE ONLY1
ME
OEM
MEMO
No
MEN
MM
ME
OEM
MEMOMMEM
MMIMMMONIMM
NEW
MENOMMIN
MIMIREMENIMEM
MEMO
MENEM
MIN
0-
0
1MOM1
MENNEN
OMEMSEMMIMEMENEIMEN
0
SOMEONE
ONMEMEMENROMENIMEM
�111111
Installing Company Name Boule Is Gas
Address 39 Oxford Avenue
Haverhill, MA 01835
Business Telephone 978-372-6783
Name of Licensed Plumber or Gas Fitter
Charles H. Boule"
Check one:
0 Corporation
0 Partnership
;a Firm/Co.
Certificate
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantlW equivalent which meets the requirements of MGL Ch. 142.
Yes Z No 0
If you have checked Yes, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy �ff Other type of indemnity 11 Bond C1
OWNER'S INSURANCE WAIVER: I am aware that the licensee.�Loes 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:
Owner0 Agent 0
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 i§;uedAor this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of
BY T of License:
Plumber Signiture of Licensed Plumber or Uas Fitter
Title Gasfitter
Master License Number J35��7
City/Town iliJiou f n eym an
Ap0FVyE0—MT 7ISE ONLY1
MASSACHusETTS UNIFORM APPLICATION FOFt PERMIT TO 00 GASFITTING
(Print or Type)
NORTH ANDOVER Mass. Date 0
Permit # 14-ZL—
�uilcling Location fq Sj
TcMlOE f/� 6 L oa_�
Owners Name
New -7 Renovation Replacement Plans Submitted 0
Ely7
(Print or
Type)
Check one: Certificate
Installing
Company Name
c' 0
Corp.
Address
Q t/
JT
Partner.
a2ld
v z 9 -?S
Firm/Co.
Business
1,
Telephone: 3 22 2,3x
Name of
Licensed Plumber or Gas Fitter
C
Insuranc(- Coveraq Indicate the type of
insurance coverage
by checking the
MENNEN
ME
MEE
MEE
REMENEEM
NAMEMEMEEMMEMEMEMIN
MEN
MEN
WEE
ME
MEMMEMEMEM
ME
MINIMEMMEEMIN
ENENEN
KNEENNIEN
KNEEME
MEE W;
MEMENNEEMENESEEMENE,
WITORTMENERIEN
KERIMENEENEENEENER
(Print or
Type)
Check one: Certificate
Installing
Company Name
c' 0
Corp.
Address
Q t/
JT
Partner.
a2ld
v z 9 -?S
Firm/Co.
Business
1,
Telephone: 3 22 2,3x
Name of
Licensed Plumber or Gas Fitter
C
Insuranc(- Coveraq Indicate the type of
insurance coverage
by checking the
appropriate box:
Liability insurance policy Other type of indemnity = Pond
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 coverages.
Signature of owner/agent of property Owner El Agent
I hcreby certify that all of the dccAds and information I haye submitted (or entered) in above application are true and accurate to the best of mY
knowledge and tlLat ill plumbing work and WEAUations performed under Pe(mit issued for t" application wW be in compdance with ag pertinent
provisions of tho Massachusetts State Cas Cude and (IIAPtcf 142 of tho Cknexal Laws.
By
Title
City/Town:
APPROVED (OFFiCE USE ONLY)
TYPE LICENSE:
Plumber
Gasfitter Signatul�el of Licensed
Master Plumber or Gasfitter
Journeyman -
Licr_"-nse liumber
CO �_ �5_74-5
Date............ .........
"ORT#q 11 TOWN OF NORTH ANDOVER
04.
PERMIT FOR GAS INSTALLATION
T1
This certifies that ..... .................. . ............
T C,
has permission for gas installation
in the buildings of .... I,"
..............
- — . 1� .....................
I
at ............. /..
..................... .,,NNOrth ver, Mass.
Fee.� Lic. Noe�' ......... ....... ........ .
.,r Ifrio/94 13:17 17.50 AS INSPECTQ8
J,
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 'Go-
N2 34641 Date . ..........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that . ...............................................................
has permission to perform ........ v; ............ * .............................................
wiring in the building of ....... .............. ......................
at ............ 4n .......... ........... . North Andover, Mass.
Fee.-.. . ....... Lic. No.// '1, 11147
............. ......................... ..................................
ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
11
I
Tamraunfuealth urf ffiasoar4usetts OFFICE USE ONLY
Department of Public Safety Permit No.
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Utility Authorization No.
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
please print in ink or type all Information Date:
City or Town of: �bej�o Wlmer -
To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below
Location (Street & Number):
Owner or Tenant: V, AOLAWMV)Q)
Owner's Address: SLI M�Q
Phone:
Is this permit in conjunction with b *Idin p rmit? 01- 1es 0 No (check appropriate box)
Purpose of Building: M1 U
/ Volts Overhead 0 Undgrd 0 No. of Meters:
Existing Service:— Amps
New Service: — Amps Volts Overhead 0 Undgrd 0 No. of Meters:
Number of Feeders and Ampacity-
Location and Nature of Proposed Electrical Work: \0JPC-ffiaJ Fyi 4+) raj10J9QJ
No. Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. Lighting Fixtures
Swimming pool
Above
gmd.-
n -
gm1d.
Generators KVA
No. Receptacle Outlets
No. Oil Burners
No. of Emergency Lighting
Battery Units
No. Switch Outlets
No. Gas Burners
121.14FAW11:17711 No, of Zones
--------------------------
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/So unding Devices
Localo ClMun�cipa,E] OTHER:
onnection
No. Ranges
Total
No. Air Cond Tons
No. Disposals
No. of Heat Total Total
Pumps Tons KW
No. Dishwashers
Space/Area Heating KW
No. Dryers
Heating Devices KW
No. Water Heaters KW
No. of
Signs
No. of
Ballasts
Low Voltage Wiring
No. Hydro Massage Tubs
No. of Motors
Total HP
U I MEH:
INSURANCE COVERAGE: Pursuant to the requirements of Massachu�' etts General Laws I have a current Liability
Insurance Policy including Completed Operations Coverage or_;s substantial equivalent. YES C] NO 0
I have submitted vaild proof of same to this office. YES V NO 1`7
If you have check 'YES', please indicate the type of coverage by checking the appropriate box.
INSURANCE ;��OND 0 OTHER 0 (please specify):
Estimated Value of Electrical Work: $ (expiration date)
Work to Start: Inspection Date Requested: Rough Final
Signed Under the Penalties of Perjury:
FIRM NAME:
E�-ec�r ic, Lic. No:
7VLicensee: Signature: Lic No:E
Address: �(04 EQ115f A It #
OWNER'S INSURANCE WAIVER: I am aware that t,h "e'Licensee DOES NOT HAVE the insura'nce coverage ot its
substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application
waives this requirement. OWNER AGENT (please circle one)
Signed: Telephone No. Permit Fee: -
WHITE - OFFICE COPY * YELLOW - CONTRACTOR'S COPY - PINK - POSTED COPY
DATE SCHEDULED 11-27-01
BARROS ELECMC INC.
BU,LING-ADDRESS
METHOD OF PAYMENT
CUSTOMER Mark Hammond
Precision Construction
STREEr., 296.Appleton StreeL.
5...C,(=Ave
TOWN No. Andover, MA
Woburn, MA
PHONE home .978-687-0272..
Const. Manager Robert Aflen office
781-938-0444 cell 781-589-2118
Brian_ 781m5894_723
T&M... CONTRA, CT
Wire the addition master bath room
DATE: 11-27-01 NAIME Rob + Josh
HOURS
DATE. - NANE_
HOURS
DATE. .. � NAME - _
HObRS.
L