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Home My WebLink AboutMiscellaneous - 294 CHESTNUT STREET 4/30/201812 w TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING PLUMBING INSPECTOR H�l 0 .4- ,C\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK kqLw4w CITY J_North Andover I MA DATE 108/17/2015 1 PERMIT# JOBSITEADDRESS 294 Chestnut Street LL�j OWNER'S NAME�_Lynn Wentzell POWNER ADDRESS 1 71 TEL� 978-689-8926 FAX TYPE OR OCCUPANCYTYPE COMMERCIAL F-1 EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: Ej REPLACEMENT: El PLANS SUBMITTED: YES L] NOE] I FIXTURES -1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB =L j L=. L -- CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM ]IF DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _71 DRINKING FOUNTAIN FOOD DISPOSER =ZZ FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) F--1 I I , KITCHEN SINK LAVATORY ROOF DRAIN T SHOWER STALL L SERVICE MOP SINK T61LET URINAL L-3 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES ------ 1= WATER PIPING OTHER 12acl Flow INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY f-1 BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of k I d 'n and that all plumbing work and installations performed under the permit issued for this application will be in compl�i��rtinent provis�inyn of e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Thomas Weeks LICENSE # r 1 �437 SIGNATURE M P '17 1 ip 'I CORPORATION:,]# -----'-IPARTNERSHIP # LLC'—'# 73083C —1 COMPANY NAME DiPietro Heating and Cooling ADDRESS 5 South Summer Street CITY Bradford STATE MA ZIP TEL'978-372-4111 FAX 978-241-7325_1 CELL--- EMAIL deanna@calldipietro.com N rlvjlq HAVI � V i te Y\,\ on L -�Jeo. navvJ v'p N Date ... ................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has perrnission for gas installation .................. . ........ inthe buildings of ............................................................................ at ................ 71.q ...... Jt— North Andover, Mass. Fee... N .. . ....... Lic. No . ..... "�I ... ..................................................................... Check # GASINSPECTOR LJ m 01�- - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North A-ndover-- MA DATE 08/17/2015 PERMIT# JOBSITE ADDRESS 294 Chestnut Street OWNER'S NAME Lyp��entzell GOWNER ADDRESS TEL 978-689-8926 FAX -1YPE OR PRINT OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANSSUBMITTED: YES NO_ APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER — -- I — � — BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM /SPACE HEATER ROOF TOP UNIT TEST J UNIT HEATER UNVENTED ROOM HEATER WATEfIHEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY —v OTHER TYPE INDEMNITY _ BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER -- AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowled and that all plumbing work and installations performed under the permit issued for this application will be in compliance wi nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. w000�� / 00� PLUMBER-GASFITTER NAME Thomas Weeks LICENSE # 8437 SIGNATURE MP —v MGF —, JP — JGF . LPGI CORPORATION , # 3083C PARTNERSHIP —# — LLC --# COMPANY NAME: DiPietro Heating i�nd C�oling ADDRESS 5 South Summer Street CITY Bradford STATE MA -ZIP 01835 --TEL 978-372-4111 FAX 978-241-7325 CELL EMAIL deanna@calIdipietro.com 01�- - Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Citv/State/ZiD:Y�C/ArAYA WOIR,��Ph..#: 6416 - 3)2 - �A � I i Are you an employer? Chec!cthe appropriate box- The Commonwealth of Massachusetts Department of IndustrialAccidents 6. [] New construction Q 'ce q ffz f Investigations IN R�-%, .,�, 600 Washington Street Boston, MA 02111 7. E] Remodeling www.mass.govIdia Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Citv/State/ZiD:Y�C/ArAYA WOIR,��Ph..#: 6416 - 3)2 - �A � I i Are you an employer? Chec!cthe appropriate box- Type of project (required): 1. W I am a employer with 4. [:] I am a general contractor and 1 6. [] New construction employees (fall and/or part-time).* have hired the sub -contractors 2. El I am a sole proprietor or partner- listed on t ' he attached sheet. 7. E] Remodeling ship and have no employees These sub -contractors have 8. n Demolition w . orking for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance., required.] 5. E] We are * a corporation and its 10.[ZElectrical repairs or additions 3. El I am a homeowner doing all work officers have exercised their I I - n Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.[:] Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.&Other employees. [No workers' comD. insurance reauired.1 *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeownen who submit this afirida vit indicating they are 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 state whether or not those entities have employeLs. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy # or Self ins. Lic. [a 00fL 12() gx—piration Date:_()] Job Site Address: -7— q C Nan sm-rfc± City/State/zip: and (vp,/ rn)9 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). a Slut Failure to secure coverage as required under Section 25A otMGL 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 afine 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 W16 --w thepainsandp Ides ofperjury that the information provided above is true and correct Date:?, 2 A Official use only. Do not write in this area, to be completed by city or town official. City or Town: PerinittlLicense # Issuing Authority (circle one): 1. Board of Health'2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #- CONTROL#J225693 IMPORTANT If Your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at fnass-gov/dpl for instructions to ensure the Proper mailing of Your Renewal Application and.any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on Your person or Posted as required by law and/or regulations. CONTROL#J225694 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpI for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. CONTROL#J2-25692 IMPORTANT If Your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass-gov/dpl for instructions to ensure the proper mailing of Your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or Posted as required by law and/or regulations. Date V'l Town of North Andover Your permit has been sent back to you for the following reasons: 1) Check amount incorrect 2) No copy of current license )v (P 0 --YO /Y /0 llf-a.—Av4e 3) insurance Binder not on file or ex ire 4) No Workers' Compensation Insurance Affadavit Form Please call with any questions 978-688-9545. Fax 978-688-9542 Workers' Compensation Form and Schedule of Fees can be found on the Town of North Andover Website under Building Department. Mailing Address: 111600 Osgood Street, Building 20, Suite 2035, North Andover, MA 01845 11Z\ 0!ftce Use Only The Commonwealth of Massachusetts U Department of Public Safety occupancy & fee Checked _2� BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12XO 3/90 (leswe blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wmrk to be Periormed In occordance %dth the Masaschusem E3cctrical Code. 527 CMR 12-00 (PLEASE PRINT IN INK OR TYPE A 0 Date "Juil"o T�_ Ulty or Town of L!�U To the Inspector of Wires: The undersigned applies for a permit to perform. the electrical work described below. Location (Street & Number) Owner or Owner's Address U ST Is this permit in conjunction- with a building permit: Yes z Purpose of Building sip, FA -M I —ultility No C] (Check Appropriate Box) Authorization NO. Existing Service Volts Overhead[3 Undgrd C] No. of Meters New Serrice ____.Amps Volts Overhead El UdgrdC:] No. of Met . er, Number of Feeders and A=pacity Location and Nature of Proposed Electrical: Work _&�ekneAi t Q�-t No. of Lighting Outlets No. of Hot Tubs Total No. of Transformers XVA No. of Lighting Fixtures �?_o JSwimming Above In - Pool grnd. C3 grnd. C3 Generators KVA No. of Receptacle Outlets 2� lNo No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets . . of Gas Burners I= ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices C] M Local Conicipal Other nnectionEl No. of Ranges Total lNo. of Air Cond. - tons No. of Disposals Hear local Total lNo. of Pumos Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers lHeating Devices XW No. of Water Heaters KW No, of No. or Sizns Ballasts Low Voltage Wirinr No. Hydro Massage Tubs 1. 1 No. of Motors Total HP Z 2- CMCI (I SO to, N INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES& NO C3 I have submitted valid proof of same to this office. YES Q9 NO 0 If you have checkeci YES, please indicate the type of cover�,� checking the appropriate box. INSURANCE 4J BOND (:] OTHER 17 (Please Specify) Estimated Value of Electrical Work S Dati—) Work to Start Inspection Date Requested: Rough Final Signed under the enalties of perjury: FIRM NAME 41, 1 — LIC. NO__41C?3Z Licensee S - Xt� 74-10 4 11�� &7 Signature LIC, NO.1459.3-3 _Alp _ey4r J?7 Address /6 Z. 4,510e 7,3. -7 No. --Alt". Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or-it—s Sub- stantial equivalent as required by Hassachusetts 4eneral Laws, and that my signature.on this permit application waives this requirement. Owner Agent (Please check one) (Signature of Owner or Agent) Telephone No. - PERMIT FEE S q rVLASSACHUSETTS UNITFORM APPLICATON FOR P MNLIT TO DO G.AS bTI-IINC, �Type or print) Date PIUK I n Al -I Uki V zri, iV1tkj0^k- Building Locations 9V ez S V�4e, 9/--- !�-: Owner's Name New Renovation Replacement F� - Permitg JK Amount S e�,eI7 Plans Submirted (Print or type) 1114 Check one: Cercificate Inscalling, Company C;2 /z xj"j Partner. Date..."'" ................. Firm/Co. 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ............. ....... has permission for gas installation 1�� in the buildings o 1) 1 1 - ",7— .. . . . . . . . . . . . . . . . . f ..... . . . . , - 1, '/ at............................. .................... North Andover, Mass. Fee: I ir XT . . . V ........... Check# GASINSPECTOR one: No Bond 7 -rage required by Chapter 142 of the ient. A2ent ie appi Icarion are true and accurate to the A Issued for this application will be in �r 142 of the Geneml Laws. )r Gas F rter W-5 Tiot2r joumeyman -PPROVED wi,nu: ()SF!)NI.Y) 1 7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUM13ING (Type or print) NORTH ANDOVER, MASSACHUSETrS Building Location New F1 Renovation F1 FIXTURES Date "XI Permi7# Amount A - Plans Submitted Yes NO (Print or type) No :7 Check one: Certificate Date. P ............ artner. RTAJ of + TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 1. D 4CHUS This certifies that has permission to perform ....... plumbing in the buildings of I " at. -. . . / - 1, , ............... North ........... Andover, Mass. Fee. Lic. No..-. . .. ................ ......... Check # _/'/ V 1-1 PLUMBING INSPfCTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Firm/Co. Bond on does not have any one of theabove )plicatiori are true and 'accurate to the ,ued for this application will be in �er 142 of the General Laws. I- Joumeyman F1 Date ....... ...... I ..... ........ j ,kORTH 0 TOWN OF NORTH ANDOVER 0 0 PERMIT FOR WIRING u SS u This certifies that .................... ............ ...... ............ ................ . ........ . ...... ol has permission to perform .............................. ............ . ......... I ......... wiring in the buildijig of ..... ...................... f .................................... at ...... ................................ ...... i ......... ./ .................. . North Andover, Mass. Fee..... ........ Lic. .... ............................................................... ELECTRICAL INSPECTOR 5-5. C3 F2j WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Location 112-94 07 "e-t-qjr No Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ a- Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee(,?P---,Vl $ s. -F4 V Sewer Connection Fee $ CM Water Connection Fee $ TOTAL $ Building Inspector Div. 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C, CL CD !ci z 0 m 0 w m cio C/) 3 0 W- (b C/) 1 0 rA "71 * :3 (1) 2 -1 < gJ OQ X t- :1 0 CFO 0 00 :70 Irl 0 CL 0 :3 C/) CD e) C/) < "ll 0 0 rL tz o > M z rA M GA I -A C-0) ft. )Nq 0 ' 711'e 00,00, HOME IMPROVEMENT CONTRACTORS REGISTRATION Board Of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 103481 Expiration 07/08/96 TYpe - PRIVATE CORPORATION Manning Builders Richard J. Manning 158 Dale St. N. Andover MA 01845 OF IV MASSACHUSETTS EXPIRATION DATE 05/07/1996 RESTRICTIONS NONE 0EPARTN!E.4T0FPUBL!CSAFETY ONE ASHBORTON PLACE BOSTON, MA 02108 L I C E'ISE -ifr I SIP %C.ONSTR. SU�'=RVISOR, i,# thico"TraN EFFECTIVE DATE LIC -NO. FOR PROTECTION AGAINST THEFr, PUT RIGHT THUMB L -16/30/1993 C29877 ---------F4RINT-ft4,Af)PnPF:NATE-- 0 BOX N LICENSE. R-1CNARD J MAANING 1 158 DALE ST 0 Z Q-7634 rq ANDOVER MA 01345 - I i , S S 4 015-40 ILASTING OPERAT04S.. MU4TJ Cf4EffATOJ AA I PHOTO (BLASTING OPF1 ONLY) FEf '00.00 NOT VALID L04TX SIGNED By LICENSEE AND OFFICIALLY j HEIGHT: STAMPED OR SCANATURE OF THE COMMISSIONER Lj L; -It DOB: 05/07/1949 THIS DOCUMENT MUST BE CARRIED ON THE PERSON OF SIG 60F UCEN�SEE SIGN NAME IN FULL ABOVE SIGNATURE LINE THE HOLDER WHEN EN - OTHERS - RIG14T THUMB PRINT GAGED IN THISOCCUPATION. F3j MAS!§ACHUSETTS UNIFORM APPLICATION FOR, PERMIT TO 00 G (,Printlgt Type) mass. Date— tuildina Location 2 /--/ -5vt Permit 07ers Name &Ie4 New -7 Renovation Replacement 10 Plans Sub�itted "0 [TYING //j -- AW Insurance Coverag Indi c e of insurance coverage by.checking the appropriate box: Liability insurance policy type of indemnity [:]. Bond 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. 5V 4 -y 3 .X - Owner Agent Signature of owner/agent of property I hezeby certify that aU of (he deLsils and infotmation I have submitted (or entered) in &Love aPplicatiOn are true and accurate to the beit 46( my i knowledge and that all plumbing woric and LnstAllations vcrformcd under Permit issued fo.- this vppficztlo�n wW �bc Ln compUnce with a fin t provisions of Lho J�Usszchusetts Slate Gas Code and chapter 142 of tho General LAws. TYPE LICENSE: Plumber Gasfitter Signature of License Master Plumber or Gasfitter Journeyman 6739 License Number (Print or Type) Check/one: Certificatel Installing Company Name ANDOVER PLG. & HTG. CO. INC. Corp. 1051 Address 5731 SO. UNION STREET Partner. LAWRENCE 14A. 01843 Firm/Co. Business Telephone: 508-685-8383 Name of Licensed Plumber or Gas Fitter Monson 0 no MIKKKKE ME NONSENSE MAKEN ME MENEEMONEEMEN ME mummummon monummommommom ME IS OR SENSE a Insurance Coverag Indi c e of insurance coverage by.checking the appropriate box: Liability insurance policy type of indemnity [:]. Bond 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. 5V 4 -y 3 .X - Owner Agent Signature of owner/agent of property I hezeby certify that aU of (he deLsils and infotmation I have submitted (or entered) in &Love aPplicatiOn are true and accurate to the beit 46( my i knowledge and that all plumbing woric and LnstAllations vcrformcd under Permit issued fo.- this vppficztlo�n wW �bc Ln compUnce with a fin t provisions of Lho J�Usszchusetts Slate Gas Code and chapter 142 of tho General LAws. TYPE LICENSE: Plumber Gasfitter Signature of License Master Plumber or Gasfitter Journeyman 6739 License Number (Print or Type) Check/one: Certificatel Installing Company Name ANDOVER PLG. & HTG. CO. INC. Corp. 1051 Address 5731 SO. UNION STREET Partner. LAWRENCE 14A. 01843 Firm/Co. Business Telephone: 508-685-8383 Name of Licensed Plumber or Gas Fitter Insurance Coverag Indi c e of insurance coverage by.checking the appropriate box: Liability insurance policy type of indemnity [:]. Bond 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. 5V 4 -y 3 .X - Owner Agent Signature of owner/agent of property I hezeby certify that aU of (he deLsils and infotmation I have submitted (or entered) in &Love aPplicatiOn are true and accurate to the beit 46( my i knowledge and that all plumbing woric and LnstAllations vcrformcd under Permit issued fo.- this vppficztlo�n wW �bc Ln compUnce with a fin t provisions of Lho J�Usszchusetts Slate Gas Code and chapter 142 of tho General LAws. TYPE LICENSE: Plumber Gasfitter Signature of License Master Plumber or Gasfitter Journeyman 6739 License Number 4 *0 Date ..................... Ot ,0RTpj A TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION This certifies that ...................... i ........................ has permission for gas installation ............................ in the buildings of . , . . � ...................................... at ........ h,,North Fee... Lic. No ......... WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File S, Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHU * Foundation Permit Fee $ Other Permit Fee TOTAL Check # e -Building Inspec-tor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUELDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector 1 f B Idings 681F SECTION I- SITE INFORMATION 1.1 Propefty Address: 2,7q 1.2 Assessors Map and Parcel Number: e, Map Number Parcel Number 1.3 Zoning Information: Zoning Di�i ict Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage (11) 1.6 BURDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Req*red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: public 0 Private 0 Zone - Outside Flood Zone 0 . 1.9 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSF"/AUTHORIZED AGENT 2.1 Ownerof Record k "" le - Name (Print) Address tor Service f -2 v Stgnature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Sup6rvisor: IAddress r.1�1 's i j-.a—t.rc Telephone Not Applicable 0 License Number 41:1— Iq,- 0,�- Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number -Z Address -7>- Expiration Date Signature Telephone 00 M as -4 z 0 0 z M 0 M r r loom z 0 I SECTION 4 - WORKERS COWENSATION (NtG.L C 152 4 25,(6) 1 Workers Compensation Insurance affidavit mu5,be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildingi;dfimit. Signed affidavit Attached Yes ..... LU., -'No ....... 0 SECTION 5 Description o Proposed Work (check appHcable) New Construction C1 Existing Building 0 Repair(s) terations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: 7? SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pern-dt applicant OMCLAL USE ONLY I . Building L) (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Pemit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMEPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permi t application. Signature ofOwiier Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 5�+� A", V as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Lrue and accurate, to the best of my knowledge and belief Print N Signatmro-176 vm er/Agent Date -NO. OF STO=S SIZE -BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I s -r 2ND 3RD -SPAN -DIMENSIONS OF SILLS -DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATE RIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUU-DJNG CONNECTED TO NATURAL GAS LINE n - IV 0 0 z W *4 P5. 7�� : trig 0 LAJ LUCIO cl C.3 E - CLuj cc u x *4 P5. 7�� : trig LAJ LUCIO cl C.3 E - CLuj c. ol C, Q CL 42 CL Go c" C C cl, W 39 0 cc cc M, G 0 E =ID b- e CLOQ 16.: cm"a fA c z "a aa =31 OCL CaL = 4" C3.0 C4 C= C. 4- CL CIO M 0 c CD 0 C3, co cm 43 cz M 0 C/) rij 44 C/) z 0 0 �D 0 C/) z u C/) C/) El _k9l, 40. E CD LM 0 CL E cc co 0 cc cc LM L. CL. Cc 0 = E: cmcc cc w ci 0 CL C.3 ca COD LLI LLI uj 19 ul LU U) n - NN 6 z 14, 7r 32 ED 40 1--- 0 COD uj E L3 CO.) c ca A C3 C.3 CL cc cc 0 Goa E 4 A CF CL 'A cc cm CL.s C, 0 0 co cc . I c co CL8 .LA C2 c 0 := C42 CL cc 0 CL C42 '... =0 * — CL =0 CL= c = 4- .— ca 'o 09 Q .40 cm 32 0 CL.= 4-0 ow 10 C2 c co Im cm CIO a- 0 cm S z CD 9 CD zip C/) z IC cf) z 0 u C/) C/) 0-4 u 40. 1 CD E 0 z CL 0 C43 cm r. OA c— CL Co. 0 cc co UA A vo. �- 21 �o 7r 32 ED 40 1--- 0 COD uj E L3 CO.) c ca A C3 C.3 CL cc cc 0 Goa E 4 A CF CL 'A cc cm CL.s C, 0 0 co cc . I c co CL8 .LA C2 c 0 := C42 CL cc 0 CL C42 '... =0 * — CL =0 CL= c = 4- .— ca 'o 09 Q .40 cm 32 0 CL.= 4-0 ow 10 C2 c co Im cm CIO a- 0 cm S z CD 9 CD zip C/) z IC cf) z 0 u C/) C/) 0-4 u 40. 1 CD E 0 z CL 0 C43 cm r. OA c— CL Co. 0 cc co UA A The Commonwealth ofMassachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mas&govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): (,U L,�Jz V-� ,,i 4f — VJ, Address: 1- 3, t_t�, City/State/Zip: Phone#: Are you an employer? Check the- appropriate box: 1A. 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. E] 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. [:1 We are a corporation and its required.] officers have exercised their 3. E] I am a homeowner doing all work right of exemption per MGL myself [No workers' conip. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (requirecl): 6. EJ New construction 7. EJ Remodeling 8. El Demolition 9. E] Building addition 10.El Electrical repairs or additions 11. [:1 Plumbing repairs or additions 12. 0 Roof repairs 13.[:] Other *Any applicant that checks box # I 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 sucli. tContiactors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy inforniation. I am an employer that is providing workers I compensation insurancefor my employees. Below is the polky andjob site information. Insurance Company Name: P0IiCy#0TSelf-ins.Lic.#: 0?-UJ0M1-V_L4 Expiration Date: -2-,;- -c>5- Job Site Address: 2—.1-1 (f (,_04,4 , f A City/State/Zip: 44 -*,4 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 certift under * pains andpenalties ofperjury that the information provided above is true and correct Phone #: -7, 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 *b Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. pursuant to this statate, 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 6r 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 all 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' co . mpensation 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 nurnber. 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 "an 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 Revised 5-26-05 www.mass.gov/dia X� North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (415- t (Location of Facility) ,-,0" -S, ignature of Permit Applicant C— 3 — C::� S— Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector V") Q -L 0 t2 (0 Sold To: Address: city: / /. Job site Address (if different): 19. 20. 21. 0 22. 0 23. 1:1 HIC Registration #129774 Federal ID #04-3277886 Pella Windows & Doors of Boston "Viewed to be the Best" WINDOW CONTRACT -//Z 64e//C,,71Z7C- Pella Windows & Doors 45 Fondi Road Haverhill, MA 01832 PH: (800) 866-9886 Service: Ext. 124 Fax: (978) 556-0394 Sales: (866) Pella06 — Date: 77-5� . Phone(Horne) r7V- State:^1 Z i p: L`/� 54E V�' — Phone (Work) Phone (Cell) Total Project Amount $ Financed If Yes: Amount Oinanced $ (Reference # Deposit Received $ Balance on Substantial Completion $ (Payment is payable to installer at completion of job) PELLA IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS. PLEASE REMOVE ALL SHADES, VERTICALS, BLINDS, CURTAINS, DRAPES ORWINDOW MOUNTED AIR CONDITIONERS, PRIOR TOTHE INSTALLATION OFYOUR NEWWINDOWS. INSTALLERS ARE NOT RESPONSIBLE FORTHE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. CONDENSATION INSIDE THE HOUSE DOES NOT INDICATE A WARRANTY PROBLEM. SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE ANY REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO OR RELIED UPON BY "OWNER". YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE OF THIS AGREEMENT. CONTRACT SUBJECTTO FINAL INSPECTION BY PELLA CONSTRUCTION DEPARTMENT. TERMS AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE. This contract is a legal document. Your Pella products will be specially made-to-order for you. UNDER NO CIRCUMSTANCES WILL REVISIONS OR CANCEL i THE THIRD BUSINESS DAY AFTER THE CONTRACT HAS BEEN SIGNED AND DEPOSIT PAID. BY SIGNING BELO—W ATTHE ABOVE SPECIFICATIONS FORTHE PELLA PRODUCTS YOU ARE ORDERING ARE CORRECT. oe Pella Rep. Signature: Date: Date: Customer Signatur I.— — -I.— V�11—., r'—+--- Pink - qtnrp, z w Cl) 00 co C) '2 co z 0 ot to (D E LLI 0 a. t- C-4 CD i� ul m ui w D (n Q� L: > 0 0 0 .0 CL (3 Z co OD FL z Cl) 00 L- OD 0 0 C) C,* -4 col) 0 N LL U) 0 z co a 0 Ir 0 CM 0 0, C) lu cwn =) < 0 3: a- < 0 rww jr UJ Ol LO U) co X 0 0 '2 z 0 ot to (D E Z t- C-4 CD i� ul m ui �; CL C4 - :3 ch (n Q� > 0 0 0 .0 CL FL z Cl) 00 LU ul 0 Uj 0 in cc C 0 Lt z w 0 w j 0 LL > Lu U) 6- * 0 Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ 2 MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C'.*) e c k # 7 Building Inspector TON" OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING TW_$ft`b9*r*rA Wi"Uft oily BUILDING PERNUT NUMBER/g., DATE ISSUED: SIGNATURE: / "/v Buif&ng Com6ssion-6r/InEeEtor of Buildings Date SECTION I -SITE INFORMATION 1. 1 Property Address: 29q ckez&v1 s-Avc,/ 1.2 Assessors Map and Parcel Number: 8 Number Parcel Number AMap 1.3 Zoning Information: Zoning DisUicl, Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public X Private 0 1. 1 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal X On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record X e ; A Natic (Print) Address for Service: 9?�8_�0_89U Signafure Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction (4upervisor: Seelltj A),d 03 0 Addres 0 663 <1 Signature Telephone Not Applicable 0 8.8 )t/7, License Number 8 -30— zoo/ Expiration Date 3.2 Registered Home Improvement Contractor ake,_k aloe.. &19�rr Not Applicable 0 lad87?1: Company Name Q YAle-I& A/ 0a, 0 1,9 Address Registration Number eas ExpirationDate Signature Telephone SECTION 4 - WORI(ERS COMPENSATION (M.G.L. C 152 § 25c(6) I Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... X No ....... 0 SECTION 5 Description o Proposed Work (check appUcable New Construction 0 Existing,.Building 0 Repair(s) 0 Alterations(s) 0( 4ddition 0 7. Accessory Bldg. 0 Demolition X Other [I Specify Brief Description of Proposed Work:0. Dani o L ki c, ei Wcxl A.X 1-0 SAI V e- 44Y,4 1?40��CYM&4 W I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY I . Building ,:� 3 6 SA12, (a) Building Permit Fee Multiplier 2 Electrical 3 6 00 (b) Estimated Total Cost of Construction Plumbing &6so- Cho Building Permit fee (a) x (b) .3 Mechanical (HVAC) .4 5 Fire Protection 6 Total (1+2+3+4+5) 9 7— Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AQgNT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby— /ithonize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 2&j A44—,S as Owner/Authorized Agent of subject property Hereby declare that the staterrfents and information on the foregoing application are true and accurate, to the best of my knowledge and belief '0W P L Al Sirgature of ONwfer/ARent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TJIVIBERS 2 ND 31w SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGIIT OF FOUNDATION TMCKNESS SIZE OF FOOTING x MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE C/) m m -7) m m m Cf) m C/) 0 m 0 C/) cn n 0 z cn C� n �J cn 1--i 0 cn dc CD 9 Q z cc CO ca CA rr col -F c cc -0-0 -* r 0 =C, cr Ll 0 CO =awo ca C2 06 C-) CL CL =r 0 IE 0 Z!5. cc) 0 LA. C2: c CD: co, CL C -i -C 0 0: CL-% CD C, 0 CL :E cl L4) ct) 0 =r CD FS. CA .0 CD CD CD CD co wo: CL,S: nc2: 0 CA 0 CD =r 0 CA coim i� m CD Cl) C3 m CO) 0 CD C, C7 S. : - um CO2 0 cn cn 91 "X PO CA z n CD Z 171 1=6 C') al CL CA C-) CD :3 0 CL cr 0 ::r- a 010 CD Er CD 0 CD w w C. CD A COD" 0 CA CD CA cp 0 10 CD z CD CD 0 C/) cn n 0 z cn C� n �J cn 1--i 0 cn dc CD 9 Q z cc CO ca CA rr col -F c cc -0-0 -* r 0 =C, cr Ll 0 CO =awo ca C2 06 C-) CL CL =r 0 IE 0 Z!5. cc) 0 LA. C2: c CD: co, CL C -i -C 0 0: CL-% CD C, 0 CL :E cl L4) ct) 0 =r CD FS. CA .0 CD CD CD CD co wo: CL,S: nc2: 0 CA 0 CD =r 0 CA coim i� m CD Cl) C3 m CO) 0 CD C, C7 S. : - um CO2 0 cn cn 91 "X PO z n P:j 171 cp al 5 4 0 t" :3 0 0 ::r- a 010 8 .9 0 z C/) to GO 0 z 0 0 k— C^ I 0 41� location* The Cominonwealth ofMassachusetts Department of Industrial Accidents' Offft Of 1,7Yes&yzAvffs 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit city phone# E] I am a homeowner performing all work myself [) I am a sole proprietor and have no one working, in any capacity am am MMUMM= F1 I am an employer providing workers' compensation for my employees working on this job. 1 0 the followmig workers' compensation polices: one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.60 a day against me.' I understand that a copy of this st2tement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the Print name penalties . � . Vperjury that the information provided above is true and correct. H-ZO-0/ # 603-17M-080 official use only do not write in this area to be completed by city or town official city or town: permit/license # riBuilding Department oLicensing Board C] check if immediate response is required [3Selectmen's Office oHealth Department contact person: phone#; ---00ther (revised 3/95 PIA) 0 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS 048847 Birthdate: 08/30/1964 Expires: 08130/2001 Tr. no: 3112 Restricted To: 1 G DAVID K BRYAN 5 KELLY RD #2 SALEM, NH 03079 Administrator 00 - 3S,000 d er4o3W space (MGL C.1 12 S.60L) 1A - Masonry only IG - 1 & 2 Family Homes Failure to possess a current edition of the Massawusetis State Building Coca is cause for revocation of this license- OIG SAFE CALL CENTER: (888) 344-7233 w - HOME IMPROVUENT CONTRACTOR '6877 License or re,,istration valid for individual 'xPiration: 7/28/02 use only before expiration date. If round vpe: return to: One Ashburton Place Rm 1301 Private Corporatill Boston \14a. 02 103 8LACKDOG 811ILDERS, INC OAVIO BRYAN ADMINISTRATOR Wly Rd 6 Town of North Andover tAORTH + Building Department 0 27 Charles Street North Andover, Massachusetts 0 1845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit 9 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in /at: 34 ;�IIWJ, R "��T C/ - 960 - Wz - 9 066 � Facility location z�z k Sign-'ature ofApplicant Date - Z6,-6 / NOTE: A demolition permit fi7om the Town of North Andover must be obtained for this project through the Office of the Building Inspector. i 0 4 CONSTRUCTION CONTRACT This contract is by and between: Lynn and Keith Wentzel hereafter referred to as "OWNER", and Blackdog Builders, Inc. hereafter referred to as "CONTRACTOR" for work at 243 Chestnut Street, North Andover, MA 01845, dated December 21, 2000. This contract consists of this document, any plans, the Specifications and Business Terms that are enclosed. 1. CONTRACTOR'S DUTIES —GENERAL a. To direct and control the work contracted for in accordance with the terms of this contract and all applicable codes, laws, and regulations, and as the building permits issued for this project, if any, require. b. To inspect the site, examine the plans and specifications, if any, and supervise all of CONTRACTOR's employees, and to direct the work of all subcontractors selected by CONTRACTOR. c. To maintain the work site in a safe and clean condition, to the extent consistent with the contract. d. To advise the OWNER promptly if concealed conditions are ascertained which require additional or different work, and to proceed in such event in accordance with this agreement. 2. OWNER'S DUTIES — GENERAL a. To provide adequate utilities for the work agreed upon. b. To advise the CONTRACTOR of any condition of the property which affects CONTRACTOR's ability to perform. c. To provide secure storage areas for materials delivered to the work site. d. OWNER shall be entitled to make periodic inspections of the work site, provided such inspections do not interfere with the work and can, in the judgment of the CONTRACTOR, be made safely. Any other entry onto the construction site shall be at OWNER's risk. e. OWNER shall notify his insurance agent of the execution of this agreement and obtain any necessary riders to his current coverage or any locally customary forms of coverage, such as builders risk, to cover OWNER's interests and liabilities during the construction process. 3. MATERIAL SUBSTITUTION CONTRACTOR reserves the right to substitute other materials, products and/or labor of equal or superior quality. E = 81 =1 IF-IVA CONTRACTOR shall not be responsible for delays caused by events beyond the control of the CONTRACTOR, including but not limited to: strikes, war, acts of God, dots, governmental regulations and restrictions. Delays caused by OWNER's failure to make allowance materials selections or caused by the performance by CONTRACTOR of extras or necessary work (as described in Paragraph 6) shall likewise be excusable delays. Q 5.INSURANCE CONTRACTOR agrees to maintain all necessary forms of insurance to protect the OWNER from liability for any occurrence arising from the performance of this contract. CONTRACTOR agrees that he shall cover his own employees for worker's compensation and carry general liability, and that all forms of insurance carried hereunder shall be with reputable companies licensed to do business in the state where the project is located. 6. HIDDEN, CONCEALED and UNFORESEEN CONDITIONS a. The parties agree that in the event CONTRACTOR discovers a condition requiring an extra cost that they shall proceed as follows: The CONTRACTOR shall notify the OWNER verbally at once to expedite agreement as to the charge to correct or cure such condition, and provide a written Work Order as soon as practicable. The parties must agree to such extra charges, or agree to a resolution method, or this contract may be cancelled by either of them. b. For purposes of this section, a "hidden, concealed and unforeseeable condition" shall mean a condition not readily observable to a prudent CONTRACTOR inspecting the subject property for the purpose of performing this contract. c. Any change in the required work by building officials assigned to this project, including structural and/or any environmental hazards will be billed as an EXTRA charge to this contract and paid for by the OWNER as a Change Order. 7. EXTRAS a. Any extra work or materials desired by the OWNER shall be agreed upon in writing and such extras shall become a part of this contract by Work Order. Unless otherwise agreed, extras shall be paid for as performed. Failure of the OWNER to sign a change order shall not preclude recovery for same by CONTRACTOR, and acceptance of said extra work or materials shall be presumed, unless there is written notice to the contrary. b. CONTRACTOR shall advise OWNER at the time of agreement on an extra as to any additional time required to perform this contract. 8. ESCALATION CONTRACTOR reserves the right to pass on additional costs to the owner for escalation of the cost of lumber or lumber byproducts. This cost may be passed on only, if after the contract is signed but before the project goes to construction, an increase in lumber costs is experienced. The contractor must substantiate the change with evidence or lumber costs at the time of the contract vs. lumber costs at the time of construction. Only direct cost differences may be passed on, no allowances for overhead and profit may be included. 9. EXCESS MATERIALS ON SITE CONTRACTOR routinely stocks extra materials on site to improve efficiency and reduce the likelihood of running out of stock in the middle of a task. Unless specifically stated all excess materials on site at the end of the project are the property of CONTRACTOR. 10. SUBCONTRACTORS a. CONTRACTOR shall select subcontractors as required to complete this contract. OWNER acknowledges that various portions of the work will be done by subcontractors. Any subcontractor selected by the CONTRACTOR shall have all requisite licenses for the work to be done by such subcontractor. b. It shall be the duty of the CONTRACTOR to use reasonable care in the selection of subcontractors. Absent objectionable performance by any subcontractor, the selection of subcontractors shall be with the CONTRACTOR exclusively. The CONTRACTOR shall require all subcontractors to have such types of insurance in force as required to hold harmless and indemnify the OWNER from any claim for injuries or property damage by any agent or employee of any subcontractor. c. CONTRACTOR shall pay subcontractors in a timely manner. 11. TERMINATION AND CANCELLATION The CONTRACTOR may terminate and cancel this contract if any payment called for hereunder is not received as scheduled, provided that notice is given to the OWNER as provided below. Upon such termination, the CONTRACTOR shall have all remedies provided by law, including such lien rights as then apply. The OWNER may terminate this contract upon the following conditions: a. Failure of the CONTRACTOR, or his subcontractors, to pursue the work contracted for, absent excusable delay, as provided in Paragraph 4 above, for a continuous period of fourteen (14) days, without a written agreement permitting same, which may be satisfied by a single notation to this agreement. b. Failure of the CONTRACTOR to rectify any condition regarding which building code enforcement authority has issued a citation of violation notice, within fourteen (14) days notice of such violation, unless OWNER and CONTRACTOR otherwise agree. c. Any other failure to perform this contract required by the terms of this contract. d. No termination shall be effective unless 10 days notice of OWNER's intent are given as provided below, during which time the default may be cured by the CONTRACTOR. e. Deposit monies - Cancellation of this contract prior to start of work will forfeit any and all deposit monies collected. All deposits are non-refundable. f. You may cancel this agreement by observing the requirements of The Right of Recission Agreement you have received. g. The CONTRACTOR and the OWNER hereby mutually agree in advance that in the event the CONTRACTOR has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the Zc mer shall be required to ubmit to such arbitration as provided in Massachusetts Ge ral Laws, chapter 142A. Lynn and Keith Wentzel 50tt Hayw Designer Blackdog Builders, Inc. �_� �-: The signature of the parties above apply only to the parties to alternative dispute resolution intiated by the contractor.The OWNER may initiate alternative dispute resolution even where this section is not seperately signed by the parties 12. ENVIRONMENTAL HAZARDS a. The CONTRACTOR is not responsible for the inspection, discovery, abatement or removal of any environmental hazard including, but not limited to asbestos, lead, radon, ground water or environmental pollution at the work site, unless specifically covered in the specifications. b. In the event that any hazardous material is discovered or suspected during the course of construction the testing, abatement and/or removal shall be shall be the sole responsibility of the OWNER. c. Any additional costs incurred on account of suspension of the construction or changes to the specifications due to a hazard or its removal are the responsibility of the OWNER and will be handled by a Change Order. d. In the event that work does not resume within 30 days of the stoppage, OWNER agrees to immediately pay the CONTRACTOR the pro rated amount of the contract price applicable to work done up to that point pursuant to the contract. WARRANTY Owner warrants that as of the date of Closing: (1) the Property (including the land, surface water, ground water, and improvements to the land) is, and will continue to be, free of all contamination, including (a) "oil, petroleum products, and their by-products" (b) any "hazardous waste" as defined by the Resource Conservation and Recovery Act of 1976, as amended from time to time, and regulations promulgated thereunder; (c) any "hazardous substance" as defined by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended from time to time, and regulations promulgated thereunder, specifically including asbestos; and (d) any other "hazardous substance" (2) the Property is in compliance with all environmental laws and regulations; and (3) there are no underground tanks on the Property INDEMNITY -Owner expressly acknowledges and agrees that it will reimburse, defend, indemnify and hold harmless Contractor, all Sub -contractors, their successors, assigns and employees from and against any and all liabilities, claims, damages, penalties, expenditures, losses or charges (including, but not limited to, all costs of investigation, monitoring, legal fees, remedial response, removal, restoration or permit acquisition) which may, now or in the future, be undertaken, suffered, paid, awarded, assessed, or otherwise incurred as the result of: (a) any contamination, existing in, on, above or under the Property (including, but not limited to, contaminated soil, buildings, facilities and/or ground water); (b) any investigation, monitoring, clean up, removal, restoration, remedial response or remedial work undertaken on the Property; and (c) Owner's breach of any warranty given herein. 13. WARRANTIES a. The work of the CONTRACTOR, including materials and labor, shall be guaranteed for a period of three (3) years, during which period CONTRACTOR shall at its own expense correct any defect arising from its work unless it is a non -warrantable condition as set out in the Blackdog Builders Client Package b. Any and all warranties for appliances or mechanical systems shall be delivered to OWNER as the CONTRACTOR receives them. c. Not withstanding any manufacturer's warranty of any component, appliance, or system, no action may be brought against the CONTRACTOR on this contract for the performance of this work, except as provided above. 14. SEVERABILITY If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall remain in force between the parties. q 15. ENTIREAGREEMENT This contract consists of the documents defined above, and constitutes the entire agreement of the parties. It can be modified only by a written document. OWNER acknowledges that he has read and received a legible copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received a legible copy of every other document that OWNER has signed during the contract negotiation. SUBMITTED: - Jc� 0z Scott Hlaywjard' 7 Designer , Blackdog Builders, Inc. DATE: ACCEPTED: —it " DATE: Lynn and Keith Wendel ALL INTERESTED PARTIES: DATE: DATE: MAKE SURE ALL INTERESTED PARTIES TO THIS CONTRACT HAVE RECEIVED THEIR COPY OF THE RIGHT OF RECISSION DOCUMENT Blackdog Builders, Inc. NoVice 9f CaPcellation Recieved on I-Z-,q?baj by_ (Date) Lynn and Keith WeKtzel You may cancel this transaction, without any penalty or obligation, within three business days of 1-7 - Z 0".) 1 (transaction date). If you cancel any property traded in, any payments made by you under'the agreement, and any negotialbe instruments executed by you will be returned within 10 business days following reciept by the CONTRACTOR of your cancellation notice. Any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the CONTRACTOR, at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement: or you may, if you wish, comply with the instructions of the CONTRACTOR regarding the return shipment of the goods at the CONTRACTOR'S expense and risk. If you do make the goods available to the CONTRACTOR and the CONTRACTOR does not pick them up within twenty(20) days of your notice of cancellation, you may retain or dispose of the goods without further obligation. If you fail to make the goods available to the CONTRACTOR, or you agree to return the goods to the CONTRACTOR and fail to do so, then you remain liable for performance of all obligations under the agreement. To cancel this transaction, mail or deliver a signed and dated copy of this Notice of Cancellation or any other written.notice or send a telegram to: Blackdog Builders, Inc. 5 Kelly Road, Unit # 2 Salem, NH 03079 603 898-0868 Not Later than midnight of 1--r- 7-ce I (Third (3rd) day after transaction date) I hereby cancel this transaction. OWNER Date BUSINESS CONDITIONS TO THIS CONSTRUCTION CONTRACT This contract, dated Dec 21, 2000 is by and between: Lynn and Keith Wentzel 294 Chestnut Street North Andover, MA 01845 Blackdog project code WentzOOO (hereafter referred to as OWNER), and Blackdog Builders, Inc. 5 Kelly Road Unit # 2 603 898-0868 (hereafter referred to as CONTRACTOR). Work will be performed at: 1 294 Chestnut Street, North Andover, MA 01845 1. GENERAL This contract is for the following work and materials to be performed by the contractor on the property address shown above. The project is generally described as follows: Kitchen Remodeling project The contract consists of this document, any plans, the itemized estimate, the specifications, and the Construction Contract. 2. PRICE The total price for the work agreed upon is $44,992.92. Payment terms are set out below in Paragraph 6. We may withdraw this proposal if not accepted within thirty (30) days. 3. STARTING AND COMPLETION PROVISIONS The work will begin on approximately and will be completed, absent unusual circumstances, on providing this proposal is accepted when presented. The dates reflect our present workload. Projects are assigned a slot in our work schedule as they are accepted, on a first come first served basis. These dates may move based on completion time of the project that immediately preceded yours. 4. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW a. All work to be done under this contract will be in accordance with the county codes. The contractor shall obtain all necessary permits and pay all required permit and plan fees from the contract sum, unless otherwise agreed. Does not include any fees which may be incurred for a variance if required. Contract price doesn't include any unbid items required by the local building official. b. All home improvement contractors/subcontractors working in the state of Massachusetts must be licensed and registered by the Bureau of Building Regulations and Standards, One Ashburton Place, Rm 1301, Boston, MA 02108, contact: Director of Home Improvement Contractor Registration at 617 727-3200. All inquiries concerning the contractor should be transmitted to this office. In Massachusettes Blackdog Builders, Inc. operates under License number CS048847 and Registration number 106877. Unfortunately at this time home improvement work performed in New Hampshire does not require any license or registration. 5. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP a. This contract will be completed by the contractor in a good and workmanlike manner, using good quality materials. b. If applicable, the contract price includes the following allowances: See allowances under specifications. 6.PAYMENT a. Timely payment by the owner of all sums due under this contract is of the essence to this contract. The parties agree to the following schedule of payments: Deposit with this contract: $2,250.00 Payment Schedule Payment 1 - Due: for Deposit in the amount of $2,250.00 Payment 2 - Due: for Begin Work in the amount of $12,500.00 Payment 3 - Due: for Begin Rough Ins in the amount of $10,500.00 Payment 4 - Due: for Begin Cabinet Install in the amount of $8,500.00 Payment 5 - Due: for Begin Flooring in the amount of $5,500.00 Payment 6 - Due: for Substantial Completion in the amount of $4,500.00 Payment 7 - Due: for Complete Punchlist in the amount of $1,242.92 Allowances for Owner Selected Components b. The contractor may cease operations if any progress payment is not made by the owner as required herein, and proceed to collect any balance due with any legal remedy. Payments are due when the reason and/or date has been reached. It is understood that minor adjustments to the payments schedule may be necessary due to the flow of work or delays beyond the control of the contractor. THESE CONDITIONS MUST BE ACCOMPANIED BY THE CONSTRUCTION CONTRACT / I N2 Date.j... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... r ................................. has permission to perform .......... ...... ............................... wiring in the building of ............. ....... .......................................... at .............. /7 ............ . North Andover, Mass. .. .......... ............ , ...... Check # //1iL6C-MCAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 106 N IHE(VAMUNWAe4L]HUPI)IAL�L"(-"VaEll)� Ullice L)SO Only DEPARTAMWOMBLICS4FE7Y Perrrdt No. BOAM OFFREPREVEMONRWHATIOAS 527CWR 12.00 Occupancy & Fees Checked IV4 UMPUCATION FOR PERW TO PEUORM IMECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MAssAcHussTs ay)cmm CODE, 527 CMR 12:00 — Date (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) g_ 15 1A1101 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street &Number) SJ Owner or Tenant J- /, y.4 n ekiT2 c-( Owner's Address Is this pen -nit in conjunction with a building permit: Yes =No (Check Appropriate Box) Purpose of Building g tek -e IN P -W 0 J C ( Utility Authorization No. Existing Service Amps Volts Overhead r7 Underground No. of Meters New Servi Amps Volts Overhead M Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. oftighting Outlets No. ofHot Tubs No. offransformers Total KVA No. of Lighting Fixtures V Swimming Pool Above 1:1 Below Generators KVA 10 / ground eround No. ofReceptacle Outlets No. of0il Burners No. ofEmergency Lighting Battery Units A N#VT of Switch OWets No. of Gas Burners FIRE ALARMS No. ofZones No. of Ranges No. ofAir Cond. Total Tons No. of Detection and No. of'Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. ofSounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal F7 Othe-r No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis 14". Hydro Massage Tubs No. of Motors Total HP OThER - Iha%eaa=tLdjkhs"=PobLyniukgCmVkleOpaafi.cmCovaaWcrilsmbsortdeWi�� YES EJ NO Ihme%bmftdva1idpiafbfmrne1odxOffM YES F1 No F-1 If�culmedudWYESpi=mdc*txWofwvaaEpbydakirgthe ,WM bcv- 6:�n ( / L Ji /Z - U�S�E F1 BOND r7 OfflER M ftmspe*) D& WorkioStat Ll 01 S1,3101 F&rgkdValwdV&cft-aWo& LL--==� h4ectionD*RWstod Ra# Final SigrwundoM i cfpaita�y - 1, - FIRMNAME id� C , --r - i,� " &1J L( C A rWrFkc � 0 (-j � V. L) , Jo K 3 3 �1?0 IF, 0-30J-3 Busiim Td Nh Ak.Tbl.�,h 3 3Z 20 F -S 41J 2 _ 42-3-3 OWNER'S Rq9JRAM-TWAIVERI amm=dathel-ioms�dn not Caied Laws and ditnTyggEAoecnftpeantWpficafimvva'rttstis rawmilat (Please check one) Owner Agent 1:1 Telephone No. PERMIT FEE $