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Miscellaneous - 326 FOSTER STREET 4/30/2018
259 Date . �IVIV ......... . TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION p This certifies that�.7i4f..Y�P�`?-S has permission for mechanical installation in the buildings of . ,-)e. �`e.-6CI : " ' �j............. at .. �?�'� • S�" " • • • • • • , North Andover, Mass. Fee. s�/O.--. Lic. No... ...... ......... ....... GAS INSPECTOR (�(� WHITE: Applicant CANARY: Building Dept. PINK: Treasurer AV', LC, LJ IL IV;4Vhrn Comn'onwealth of Massachusetts Sheet Metal Permit 11 J' JI"J 1. If L Date /T-ZQ/ P'ennit # Estimated ;lob Cost: �. permit Fee: S 0'?/o , Plans Stubmitted: 'YES r � N '� Plans Reviewed. YES NO Baiiness License# l _ Applicant License # Business Information Property Owner /Job Location Information-. Name-7R�(G Name: _ t u cll� u _ I` Street: _ 1 / Ia Street: j -d -(a F&A er S�� 0-0- City/Town: City/Town;�t.,�(a, Telephone: Telephone: �o�q9 a 7 7 Photo 11). required / Copy of Photo I -D. attached: yFS. NO s(Or lual J-1 / M-1 -unrestricted license 1-2 / H -2 -restricted to dvvellings.3-stories or less and comincrcial up to 10,000 sq. ft./ 2 -stories or less . Residential: 1-2 family ':�- Multi. family Condo / Townhouses Other Comxnereial: 0mce Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. .ft. over 10,000 sq. R. Number ofStorlest Sheet metai work to. be-m1hpleted, Mw Work: Renovation: HVAC Metal Watershed Roofing Kitchen. Exhaust System Metal Chimney /'Vents Provide detailed description of work to be done: ►� � 11 „� C�� the Air Balancing M !• LC• L d I L IV-.41MM 1", J I-7 .I • Li I I INSURANCE COVERAGE: l hays a current flab i Insurance pulley or Its equivalent which meets the requirements of M,G.L. Ch.112 Yes o Q it.you have cheakad Yes• indicate the type of.coverage by checking the appropriato box below: !!// A liability lhsuraj�co policy Other type of.iri demnity ❑ Band ❑ OWNER'S INSURANCE WAIVERO-6m curare that the licensee does not have the Insurance coverage required by Chapter 112 of the Massachusetts General taws, and that my signature on this permit application will this requirement. Cheek ono Only Owner Agent ❑ Signature or Owner or Owners Agent 13y checking thIs_bas[], I hereby certify that all of the details and Infornniion I have submitted for entered) regarding thea application ere true and accurate to the beat of my knowledge and fthet all aheal metal work and Insieliattona petfuttned under the permit issued for this application will be In comptlence tikllh all pertinent provlslon of the M1iassaehusetts Building Cade and Chapter 112 of the Genaeal Lew& Duct inspection required prior toInStflatiOh installation: YES NO PrO reels Itungbections . Date Comments �Flnat �s�ection Date. � — Coxn�ts Type of l-lcansec e}` — ❑ Master Tia. {� Master- Resiricted` C(ty.!Tcwn ❑Journeyperson + Permit # Signature of Lec�ensee ❑Jpurneyperson-Restricted Fee $ License Number. Check aty+rtr mass.govldpl Inspector Signature of Permit Approval 210 Main Street North Reading Massachusetts 01864 Phone: 1978 664 5023 wwwm alairs stem com NAME: Dan Delgaudlo PHONE: 1-617.224-2774 DATE: ADDRESS: 326 Foster' t. other: 01-29-14 TOWN: North Andover, MA 01845 E-MAIL: Pg. 1/1 We hereby submit specifications and solutions for: Furnishing and installing a new high efficient central air conditioning system for your home. Condensing unit will be installed outside of the house on a pre -cast pad. Air handler will be installed in the attic. Air handler will be hung from the roof rafters with 3/8" threaded rod. Underneath will be an emergency drain pan, gravity drain, EZ trap, and float switch. Refrigerant lines will be connected fi•om the indoor unit to the outdoor unit on the exterior of the house, encased in white plastic conduit. Fabrication, insulating, sealing, and installation of all necessary duct work. Installation of a two zone package. Two electronic zone dampers, two zone control panel, two main trunk ducts. Foln' new programmable thermostats. All electrical wiring to the existing panel. Electrical permit and inspection. Sheetmetal permit and. inspection. Complete start up and tests. A two:' , ear,service contract. on the new system. a „ T System Description y Trane XL18i condenser`` Two stage compressor Solution ?_r, Trane TAM7 variable speed air handler 17 SEER, 4 tons $17,500.00 Rebates: $500.00 Cool Smart. Will receive after job is done and balance is paid in full. Guarantee and Warranty information': This installation includes a 11-yiear c6rri•presso,r'and'_10°year parts warranty. A 100%-perf6rmance guarantee. A two year.service=.contact. on; all new products.`:. We propose hereby to furnish material and labor — complete in accordance with the above specifications, we accept option # for th-.e sum of. :$ Payment to be as follows: ❑ Financing initial- KJ/3 down, 1/3 at the start, 1/3 upon completion. All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above involving extra costs will be executed only upon written orders, and will became an extra charge over and above the estimate. Title to the equipment to remain with Royal Air systems, Inc. until the final payment is made. All agreements contingent upon strikes, accidents, or delays beyond our control. Owncr to carry fire, tornado and other necessary insurance. Our wurker is fully covered by Worker's Compensation Insurance. Acceptance of proposal: ThP ahove prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as j specified. Payment will be made as outlined above. This Proposal may be withdrawn if not accepted within 15 days from the above date. X ECu�stomer Acceptance - ure DATE Royal Air Systems, Inc. Authorization Signature Dale Commorrwealt Massachusetts Department of Public Safety Refrigeration, Contractor Licenser RC -004055 ARTHUR A P16MTT,.JR. v 48 CHESTNCJT N READING MA Commissioner \ Commonwealth of Massachusetts Department of Public Safety Pipefitter Master License: PM -002596 , t ARTHUR A PICK -ETT J "^= 48 CHESTNUT S N READING MA' 01 - Commissioner Expiration: 04/01/201'5 ' r 0 *** Continued on Next Page *** .. Reprint .. Reprint .. Reprint .. Reprint .. wri htsofte Duct System Summary Job: 9 Date: Aug 06, 2014 Entire House By: awp Royal Air Systems, Inc. 210 Main St., N. Reading, MA 01864 Phone: 1-978-664-5023 Fax: 1-978-664-1840 Email: royair@aol.com Web: www.royalairsystems.com For: DelGaudio 326 Foster St, N. Andover, MA 01845 Phone: 1-617-224-2774 External static pressure Pressure losses Available static pressure Supply / return available pressure Lowest friction rate Actual air flow Total effective length (TEL) Heating 0 in H2O 0.08 in H2O -0.1 in H2O -0.04 / -0.04 in H2O 0 in/100ft 921 cfm 0 ft Cooling 0 in H2O 0.08 in H2O -0.1 in H2O -0.04 / -0.04 in H2O 0 in/100ft 921 cfm Name Design (Btuh) Htg (cfm) Clg (cfm) Design FR Diam (in) H x W (in) Duct Matl Actual Ln (ft) Ftg.Egv Ln (ft) Trunk Room1 c 3967 0 180 0 0 8x0 VIFx 0 0 Opening (in) Room11-A c 1716 0 78 0 0 8x 0 VIFx 0 0 16x 0 Roomtt-B c 1716 0 78 0 0 8x0 VIFx 0 0 0 Room3 c 2392 0 109 0 0 8x 0 VIFx 0 0 Room3-A c 2392 0 109 0 0 8x 0 VIFx 0 0 Rooms c 2900 0 132 0 0 8x 0 VIFx 0 0 Room? c 2073 0 94 0 0 8x 0 VIFx 0 0 Rooms -A c 2187 0 99 0 0 8x 0 VIFx 0 0 Rooms -A c 907 0 41 0 0 8x 0 VIFx 0 0 -rp- wrightsoft' Right -Suite® Universal 7.1.24 RSU12485 ,4CAC;k Project2.rup Calc = MJ8 Orientation = N 2014 -Aug -06 09:05:33 Page 1 Grill Htg Clg TEL Design Veloc Diam H x W Stud/Joist Duct Name Size (in) (cfm) (cfm) (ft) FR (fpm) (in) (in) Opening (in) Matl Trunk rb2 12x 18 0 476 0 0 0 0 16x 0 VIFx rb3 Ox 0 0 445 0 0 0 0 16x 0 VIFx -rp- wrightsoft' Right -Suite® Universal 7.1.24 RSU12485 ,4CAC;k Project2.rup Calc = MJ8 Orientation = N 2014 -Aug -06 09:05:33 Page 1 40 wrightsoft- Project Summary Enure House Job: Date: 4/4/2014 By: For: Daniel DelGaudio 326 Foster st, North Andover, MA 01845 Phone: 617-224-2774 Notes: Design Information I j Weather: Winter Design Conditions Outside db 0 °F Inside db 75 °F Design TD 75 of Heating Summary Project Information Structure For: Daniel DelGaudio 326 Foster st, North Andover, MA 01845 Phone: 617-224-2774 Notes: Design Information I j Weather: Winter Design Conditions Outside db 0 °F Inside db 75 °F Design TD 75 of Heating Summary 115 58 Heating Equipment Summary Structure 56737 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Piping 0 Btuh Equipment load 56737 Btuh Infiltration Method Construction quality Fireplaces Boston, MA, US Simplified Average 0 Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 0 AFUE 0 Btuh 0 Btuh 0 °F 1622 cfm 0.029 cfm/Btuh 0 in H2O Summer Design Conditions Heating Cooling Ikea (ftp) 2400 2400 Volume (ft3) 21600 21600 Air changes/hour 0.32 0.16 Equiv. AVF (cfm) 115 58 Heating Equipment Summary Make Use manufacturer's data Trade 50 Model Moisture difference AHRI ref gr/Ib Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 0 AFUE 0 Btuh 0 Btuh 0 °F 1622 cfm 0.029 cfm/Btuh 0 in H2O Summer Design Conditions Outside db 88 °F Inside db 73 °F Design TD 15 °F Daily range L Use manufacturer's data Relative humidity 50 % Moisture difference 31 gr/Ib Sensible Cooling Equipment Load Sizing Structure 32096 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Blower 0 Btuh Use manufacturer's data y Btuh Rate/swing multiplier 1.00 ton Equipment sensible load 32096 Btuh Latent Cooling Equipment Load Sizing Structure 1810 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Equipment latent load 1810 Btuh Equipment total load 33905 Btuh Req. total capacity at 0.70 SHR 3.8 ton Cooling Equipment Summary Make Trade Cond Coil AHRI ref Efficiency 0 SEER Sensible cooling 0 Btuh Latent cooling 0 Btuh Total cooling 0 Btuh Actual air flow 1622 cfm Air flow factor 0.051 cfm/Btuh Static pressure 0 in H2O Load sensible heat ratio 0.95 Bold/italic values have been manually overridden Calculations approved by ACCA to meet all requirements of Manual J 8th Ed + Wr'ihtSO 2014 -Apr -0406:33:40 9 Rig ersa12013 13.0.06 Right J® Mobile ACCA Page 1 ...lwstmplad7ec52d-2739-44e4-80a9-bf42a5c6dc4e.rup Calc = MJ8 Front Door faces: N AL wri htsoftp Right JO Mobile Report Job: 9 Entire House Byte: 4/412014 For: Daniel DelGaudio 326 Foster st, North Andover, MA 01845 Phone: 617-224-2774 HeatingIM7 : Component Btuh/f6 Btuh % of load Walls Location: Boston, MA, US 15934 Indoor: Heating Cooling Elevation: 16 ft 26.6 Indoor temperature (°F) Design TD 75 75 73 15 Latitude: 42°N Out ng Heatingli Cooling Relative humidity (%) Moisture difference (gr/Ib) 30 34.4 50 30.9 Dy bulb(°F) Daily range (°F) - 15 ( L Infiltration: ) 20.5 Infiltration V1kt bulb (° F) Wind speed (mph) 15.0 72 7 5 Method Construction quality Simplified Average 0 0 Fireplaces p 0 HeatingIM7 : Component Btuh/f6 Btuh % of load Walls 6.8 15934 28.1 Glazing 44.6 15119 26.6 Doors 29.2 1228 2.2 Ceilings 2.4 3322 5.9 Floors 8.3 11636 20.5 Infiltration 3.5 9499 16.7 Ducts 0 0 Piping 0 0 H iification 0 0 Ventilation 0 0 Adjustments 0 Total 56737 100.0 Coolin' Component Btu hff Btuh % of load Walls 2.1 4971 15.5 Glazing 53.3 18081 56.3 Doors 11.1 465 1.4 Ceilings 1.7 2299 7.2 Floors 1.6 2265 7.1 Infiltration 0.3 925 2.9 Ducts 0 0 Ventilation 0 0 Internal gains 3090 9.6 Blower 0 0 Adjustments 0 Total 32096 100.0 Latent Cooling Load = 1810 Btuh Overall U -value = 0-161 Btuh/ft? °F Data entries checked. Gavir>g Bold/italic values have been manually overridden 1 wrightsoft- Right-Su ite® U niv ersal 2013 13.0.06 Right J® Mobile 2014 -Apr -0406:33:40 -C( ... lvvstmplad7ec52d-2739-44e4-80a9-bf42a5c8dc4e.rup Calc = MJ8 Front Door faces: N Page 1 • + wrightsoft, Right -J® Worksheet Entire House Job: Date: 4/4/2014 By: 1 Room name Entire House First Floor 2 Exposed wall 300.0 ft 170.0 It 3 4 Room height Room dimensions 9.0 ft d 9.0 ft heat/cool 5 Room area 2400.0 ft' 1.0 x 1400.0 ft 1400.0 ft' Ty Construction U -value Or I HTM Area ft' Load Area (ft Load number I (Btuh/ft2-°F) (Bt uh/ftj or perimeter (ft) I (Bt e I or perimeter (ft) I (Btuh) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6 W �-G 12C-Osw 0.091 ne 6.82 2.13 450 397 2707 845 225 198 1354 422 1D-c2ow 0.570 ne 42.75 42.57 53 0 2280 2271 27 0 1140 1135 12C-Osw 0.091 se 6.82 2.13 900 771 5260 1641 540 454 3099 967 1D-c2ow 0.570 ,se 42.75 53.28 108 0 4631 5772 65 0 2779 3463 "I 11 D0 0.390 se 29.25 11.08 21 21 614 233 21 21 614 233 VI/ ',D 0.091 sw 6.82 2.13 450 376 2564 800 225 177 1210 378 :� :2p -c2 ow 0.570 sw 42.75 53.28 53 0 2280 2842 27 0 1140 1421 11D0 0.390 sw 29.25 11.08 21 21 614 233 21 21 614 233 Vll t--1 12C-Osav 0.091 nw 6.82 2.13 900 792 5403 1686 540 475 3242 1011 C, 1 D-c2ow 0.570 nw 42.75 42.57 108 0 4631 4612 65 0 2779 2767 G 168-30ad 0.032 2.40 1.66 1400 1384 3322 2299 400 400 960 664 ---G 88cm-1 1.080 81.00 161.56 16 0 1296 2585 0 0 0 0 F 19A-Obvcp 0.295 8.31 1.62 1400 1400 11636 2265 1400 1400 11636 2265 61 c) AED excursion I(1I I 1 0 Envelope lossigain 47239 28081 1 1 30566 14959 12 a) Infiltration 9499 925 5382 524 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 3 690 3 690 Appliances/other 2400 2400 Subtotal (lines 6 to 13) 56737 32096 35949 18573 Less external load 0 0 Less transfer 0 0 0 0 Redistribution 0 0 14 Subtotal 0 0 0 0 15 Duct loads 56737 32096 35949 18573 0% 0% 0 0 -0% 0% 0 0 l 1 Total room load I Air required (cfm) 1 1 567371 320961 1 1 359491 185731 1622 1622 1028 939 _Calculations approved by ACCA to meet all requirements of Manual J 8th Ed wrightsoft' Right-Suite®Universal 201313.0.06 Right J® Mobile 2014 -Apr -0406:33:40 �'� ...\wstmp\ad7ec52d-2739-44e4-80a9-bf42a5c8dc4e.rup Calc = MJB Front Door faces: N Page 1 + wrightsoft• Right -J® Worksheet Job: Entire House Date: 4/4/2014 By: 1 Room name 2 Exposed wall Second Floor 3 Room height 130.0 ft Room dimensions 9.0 ft heat/cool 5 Room area 40.0 x 25.0 ft 1000.0 ft= TyConstruction U -value Or HTM Area (it') Load number (Bt ( ) (Btuh/f t') I or perimeter (ft) I (Btuh) I Area I Load or perimeter Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6 V� L- 12C Osw 0.091 ne 6.82 2.13 225 198 1354 422 ( 1 D-c2o`n' 12C-Osw 0.570 ne 42.75 42.57 27 0 1140 1135 0.091 se 6.82 2.13 360 317 2161 674 11 1D-c2ow 1100 0.570 se 42.75 53.28 43 0 1852 2309 0.390 se 29.25 11.08 0 0 0 0 Vjl 12C-Osw 0.091 sw 6.82 2.13 225 198 1354 422 D-c2ow 1 1D 0.570 sw 42.75 53.28 27 0 1140 1421 0.390 sw 29.25 11.08 0 0 0 0 VI/ 12C-Osw 0.091 nw 6.82 2.13 360 317 2161 674 C 1 D-c2ow 0.570 nw 42.75 42.57 43 0 1852 1845 1613-30ad 0.032 - 2.40 1.66 1000 984 2362 1634 F 8Bcm-1 1.080 81.00 161.56 16 0 1296 2585 19A-Obvcp 0.295 - 8.31 1.62 0 0 0 0 6 c) AED excursion 0 Envelope losslgain 16672 13122 12 a) Infiltration b) Room ventilation 4116 401 0 0 13 Internal gains: Occupants @ 230 0 Appliances/other 0 0 Subtotal (tines 6 to 13) 20788 13523 Less external load Less transfer 0 0 Redistribution 0 0 14 Subtotal 0 0 15 Dud loads 20788 13523 -0% 0% 0 0 Total room bad 1 Air required (cfm) 1 1 1 207881 135231 594 683 1 1 1 1 Calculations a roved b ACCA to meet all re uirements of Manual J 8th Ed. " Wriig11tC501 Right-Suite®Universal 201313.0.O6RightJ®Mobile 2014 -Apr -0406:33:40 `� ...lwstmplad7ec52d-2739-44e4-80a9-bf42a5c8dc4e.rup Calc= MJ8 Front Door faces: N Page 2 rlinnift- 7A9nn RnV'AI AIRSY ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10103/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HUB International New England 299 Ballardvale St Wilmington, MA 01887 978 657-5100 CONNAMEA Certificates Dept PHONE 978 657-5100 nlc No): 866 475-7959 (A1C, N �Ex�: E-MAIL ss: nee.certificates@hubinternational.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Travelers Indemnity Co of CT INSURED Royal Air Systems, Inc 210 Main Street North Reading, MA 01864 INSURER B: Hanover Insurance Company INSURER C: Independence Casualty Ins Co INSURER D: Safety Safety Indity Insurance Co INSURER E INSURER F: rnvconr_cc rFRTIFIr ATF NIIMRFR• KtV151UN NUMtStK: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER MMIDD�YY MM/DDYIYYYY LIMITS A GENERAL LIABILITY 16807499C754 D912812013 0912812014.EACH OCCURRENCE $1,000,000 PREMI3ESOEaEoNcauEirence $3(10'()00 COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) s5,000 CLAIMS -MADE 51OCCUR PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE 62,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 $ X POLICY PRO -ECT LOC D AUTOMOBILE LIABILITY COM1710990 9128/2013 09/2812014Eaa OMBINEDS acct rd INGLE LIMIT $1,000,000 BODILY INJURY (Per person) S ANY AUTO BODILY INJURY (Per accident) S ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS IX PROPERTY DAMAGE $ Per accident $ )g X UMBRELLA LIAB X OCCUR UHN A104686-00 0912812013 0912812014 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESS LIAS CLAIMS -MADE DED I X RETENTION s5000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N I A WC100110901 011012013101101201 I WC STATU- OTH- X E.L. EACH ACCIDEM' $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below A MTCargo 16807499C754 0912812013 09/28/201 25,000 A Installation 16807499C754 9/28/2013 09/2812014 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Blanket Additional "Insured Status and Waiver of Subrogation in favor of Certificate Holder on the general and auto liability policies as respects to operations of the named insured when required by executed contract prior to any loss/claim. rcoTrorwt•c un, nco CANCFI I ATION Royal Air Systems y y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE %�IC6C. /W C/"` @ 1988-2010 ACORD CORPORATION. All ngnts reservea. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1001085/M988009 CW001 Date..-,t.,VS� ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that..................................../.................................................. P has permission to perform ...... Q'`!......:7 �. t.......�... /- ...-:.... ..... ................ wiring in the building of......! .P.. /ya(-, d. c; at ................ '° .................. 15. ........................ I............................ , rth Andover, Ma .......... LT . Fee ,>T! l3 ........ Lic. No. ................. ..�%...................: .. ................ .,...... ELE CAL INSPECTO ,Check # �� r Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: -,? , /9' 1 / M City or Town of. NORTH ANDOVER To 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 & Number) 3 C�G \ Fo Owner or Tenant ,©�Lf,�j vo-� © Telephone No. R Owner's Address `� \� Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) l Purpose of Building Utility Authorization No. -Existing Service a60 Amps c�O /JVO Volts Overhead/ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd [I No. of Meters ci Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: N 51-� 1-L IU LAW i i✓G2 t` i9 'G' S73?fz Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above .� In E] No. o mergency Lighting rnd: rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons ......................... KW " No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local [I Connection ❑Other Connection No. of Dryers Heating Appliances r Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: c� Attach additional detail if desired, or as required by the Inspector of Wires. j Estimated Value of Electrical Work: l od t `" (When required by municipal policy.) Work to Start: J' ' )'9 ) � 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— BOND ❑ OTHER ❑ (Specify:) I certify, under t ns rend penalties of perjury, that the in Cation on this application is true and complete. FIRM NAME: J m E'S �O tJ2' ©y 3� %4N I.EC � R 1 c�,s► N LIC. NO.: (5 0 Licensee:— Al t S LIC. NO.: _ 'r l (If applicable, e ter "exempt " in the liqq�se num a line. fh Bus. Tel. No.: � c6a 7oZ Address: 6,5 < /9F • • �E�,0.Z,v6 h1 4 - 6 1 8465 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) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an 4 electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. 0. Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass IM Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL IN CTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: -7 FA DEB WEINHOLD ...TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com a The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0b Name (Business/Organization/Individual)_"V_5 n U'7 0U Address:_ 65 t w c u._ L20 City/State/Zip: J • kEA&�, hIq Phone Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have Hired the sub -contractors 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. ❑ 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.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. E] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they aie 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lie. #: Expiration Date: Job Site 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 c. 152 can lead to the imposition of criminal penalties of a Fane 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 Iavestigations of the DTA for insurance coverage verification. I do hereby certiya under the pains and penalties ofperjury Aat the information provided above is true and correct. iature- Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # 3�1g•�a Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Pers 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 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 ofpublic 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 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 Dep.aztme,ut of Industrial Accidents Office of Investigations 6.00 Washin&a Street Boston, MA 02111 Tel, # 617-727-4900 ext 406 or 1-877:MASSA.FE Revised 5-26-05 Faze # 617-727-7749 www.z�ass.gavfdia 41 F Date..�...5../Z ..... TOWN OF NORTH ANDOVER A PERMIT FOR WIRING ,(� % ` �. This certifies that .4 '! `A 7,--, 7,- v" has permission to perfo ..... ,,? C ..4.!K.t... } ........... llsfl ``?..... wiring in the building of ......... /Jfd ............................................... v s � .... , North Andov r, Mass at....3..../............................................ Fee . S S. '......... Lic. No. ........ / ,i�?? ....... .:............... qq 9LECTRICAL INSPEC M- P Check # �/3 10571 M$ Co»amonwea& ol.4 Vamac4ue cc7t% 2ep"tment 0/ ire service, BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: lalt2ll t City or Town of. f �� (} (`+ji Aydw-C41`- To 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 & Number) Owner or Tenant . H Owner's Address 5w( - Is this permit in conjunction with a building permit? Yes ❑ urpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity No ® (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Install residential security system Cnrnnletion n/ iho fnitn .. f..l.l., ..,. � 1.... ..a �...i__ n___ __ No. of Recessed Luminaires - No. of Ceil.-Susp. (Paddle) Fans ,:c W cuter ul Prires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑o. rnd. nd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o, Detection and Devices No. of Ranges TotaInitiatin No. of Air Cond. Tons l No. of Alerting Devices No. of Waste Disposers He Pump Totals: Number . Tons. KW...... No. o - Sel Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers No. of Water Heaters' Heating Appliances Kit No. of No. of Signs Ballasts Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommumcattons firing No. of Devices or E uivalent OTHER: Attach additional detail i� desired, or as required by the Inspector of Wires. Estimated Value of klectricpl Work: (When required by municipal policy.) Work to Start: a � 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 ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Nightwatch Protection, Inc.LIC. NO.: 7024C Licensee: Paul DelSignor Signatureus. IC.NO.: 7024C (If applicable, enter "exempt " in the license number line.) Tel. No.: 888-722-9282 Address: 22 Briarwood Drive, Westford, MA 01886 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. . SSC00000969 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) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. rPERMIT FEE. $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street + Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1 Please Print Legib Name (Business/Organization/Individual): �t. I C +e- chOn. Address:_OA A/n r+k wP --kf 1 of ,::�'% - ! /State/Zip: Phone #: Are you an employer? Check the appropriate box: 1.11 am a employer with 12 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 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. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp.. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.W Otherqe('� i( A S_C4,44e 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. V I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. , , I 'r Insurance Company r Policy # or Self -ins. Lic. #: VIP WEI len 6 J wo i g(p Expiration Date: %,-) IID II I Job Site Address: 3a r9 5 S City/State/Zip: WTh Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration ate). 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 the pains and penalties of perjury that the information provided above/is ttrue, and correct. Sig / Sip -nature: Date: _,9 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 #: RJS ROBERT J. SWAJIAN & ASSOCIATES, INC. INSURANCE ADJUSTERS 161 SOUTH MAIN STREET MIDDLETON, MA 01949 TELEPHONE (508) 777-1400 FAX (508) 777-2255 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Inspector of Buildings Vi (�'� vY'r+ o)�-`% RE: Our File No: Insured: Loss Location: Date of Loss: Policy Number: Board of Health or Board of Selectman SAME ADDRESSES 02-06128 KENNETH & ELIZABETH SARNI 326 FOSTER ST . Ali oV{ VIA 3-2-02 /"^/ HP 2020261 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, and claim or file number. ADJUSTERS iiiLt: On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. �. 3/x/02 ADJUS DATE NA At ASSOCIATON' NOEYENDENT 'SURAN(E ADJUSTERS 11i1. z@�•uD_ �, uy,tili ft Location �2,;1 64. � No. Date 9� �ORTN TOWN OF NORTH ANDOVER OG 9 Certificate of Occupancy $ c us `� Building/Frame Permit Fee $ !� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # „O© Building InspectorU ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS Se+etiui� for Ot kid USP t)idI ..... ......:,:.:.:. BUILDING PERMIT NUMBER: DATE ISSUED: 9 r /f SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SFCTION 2 - PROPERTY"OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record //M >e m1K e, 91 & ,oy Name int) Address for Service: �j/� /� 1y4*? K/ `f 7 ?—(ep —3 - -7� y „ 4 ; 19/Yav-del Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction 0�" Supervisor: Fj a -r. Licensed Construction Superviso Addres L --6-737 Signature elephone Not Applicable ❑ /1 CJ Li G V� �V License Number n ^ —6!y y , Eapira(tioon Date 3.2 Registered Home Improvement Contractor 41'j-Se�Y Not Applicable ❑ 3 �U Compan ame 7' �' n���1 C• c Registration Number �i f �� Expiration Dalte Addre d /_ �j'/f�> d� "t�7�-5�/J 7 Ilk Signature V Telephone M rn X ic Z O 0 0 SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) 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 .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ t Existing,Build ❑ Repair(s) ❑ Alterations(s) ❑t Addition ❑ Accessory Bldg. ❑ ' Demote ion` ❑ Other ❑ Specify Brief Description tiof Proposed Work: I SECTION 6 - FSTIMATF,D CONRTRITrTION r0R%TR I Item Estimated Cost (Dollar) to be OFFICIAL USE ONLY Date SIZE Completed bv permit applicant 1. Building - (a) Building Permit Fee DIMENSIONS OF SILLS "562 d Multiplier 2 Electrical (b) Estimated Total Cost of THICKNESS SIZE OF FOOTING X Construction 3 PlumbinE Building Permit fee (81 X (b) r p- V Ca • 4 Mechanical HVAC 5 Fire Protection -6 Total 1+2+3+4+5 Check Number S1 CTMN 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, pl "K � Was Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N b Si ature of Owner/Aen 11,111111111111 MM11911IM921 111151111 M, NO. OF STORIES Date SIZE BASEMENT OR SLAB S17 -E OF FLOOR TIMBERS I 2 ND SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I[FIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 CCT -09-2002 WED 09:09 AM FAX N0, P. 02 The Commonwealth of Massachusetts Department of Industrial Accidents ' r - OfflesuiJnlresfigatrons +xL+: 601) Wuslun,, Street Boston. MUSS. 02111 Workers' Compensation Insurance Affidavio Inc^ 6 -eReSi 6 3 [� I am a homeowner performin; all work myself. [ am a sole proprietor and have no one workin_ in any capacity ❑ 1 am an employerproviding workers' compensation for my employees working on this job. company name - e ot-,41yo poliev x t%u 52��37i Q I am a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors li ted below who have the following workers' compensation polices: comganv e• Ys rR111r . . . . . . . 0, n.. -:}r 1 VJ:•.•Y -TK . B:Vr)1A.4r.MA�S dpd... ..' .^h e, f.? �.�., '4f.R�}i r:++r:!q I}. 'G\: eompanye• e R jpsgra rice, Co. Saw Failure to secure coverage as required under Section' -5:1 of >lGt 15: can lead to the imposition of criminal penAides of a fig : np to 51,500.00 and/or one years' imprisonaent as well xa civii penalties in the Corm of a S'1'Op WORK ORDER and a fine of 5100.00 a day against me. i understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 Ito hereby cert' under the pains and Pena/tins v 'perjury thief the information provided above is true and correct Signature _ ate prini name Z/ � -"t�K_ Phone 4 � (-4—, L—_6 ,3 Official use only do not wrire in this area to be completed by city or town official city or town: pertnitilicense fi r- i3ui ling Department pLic, tsing Board aSelt tmen's Office Q check ifimntediute response is required CHet th Department contact person: phone 4; —00 r j,,,uA 1/QS NA) P 0 i t ✓% �a7rx�r�zurea/,�ii {"il�Gctddttcf2etde�4 ,d Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR jt Registration: 103358 r Expiration: 7%7/2004 Type: Private Corporation' A. J..WALSH & SONS,INC. j 'j Arthur Waish,Jr. 1 55 Pleasant St�p�- J !l N Andover, MA -01845 _Administrator ✓lze ioomv�naozurrc��i ` �/f/laaaae�itcae�6 BOARD Of BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR, Number: CS, 022680 Birthdate: 06/09/1939 Expires: 06/09/2004 Tr. no: 26824 Restricted:. 00 ARTHUR J WALSHJR 55 PLEASANT ST - E ..-* N ANDOVER, MA 01845 Administrator I 0 AJ Walsh & Sons Inc. 55 Picasunl SIrccl NhIss. HC'IiNSI d 022680 Norlll Andover, MA 01845 llstss. IZ a;ISl'IZ: YlON # 10.3.3.58 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged In home Improvement contracting, unlessspeclficaliv exempt from registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth of !Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: Registration Number: Salesperson's Name: This agreement is made on (D TE) of (ADDRL•SS) hereinafter called "Contractors",and of (ADDRESS) hereinafter called "Owner". DETAILED DESCRIPTION OF WORK 7'0 BE PERFORMED ContRctor agrees to pe(for%in a good and workinanlikSinanner all work DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials tobeb-e us in orming a above described work consist of the fol (OWNMR) (COMRACTOR) / (PIiONF NUMBER) 7f— -- S-; (PttONE NUMBER) helow. Such w,a k consists of the G (L,.., 11. PRICE 1W Contractor agrees to do all work described in Section I for the total price of S/ ®V W. PAYMENT Payment will be made as follows: 1% 90�$ -mss sem^ upon signing Contract; %(s I %OG • 7_ —� _) upon completion of upon completion of and the remaining 4'0$ tJ(i - -- arulContractor ashavutgbeetisatis�ycmpl ted,whchverificati nverifcation f the worksh ll take Place promptly after completion. Notice: No agreement for home Improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, In advance, to order and/or otherwise obtain delivery of special order materials and equipment, erecter whichever amount is IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order thjmaterials before the third day following the signing of this Agreement unless specified here in writing. Contractor wij) begin tit work ott oLa�out `� T %J�-D`j will be completed by - {- �l ._(date). Barring delay caused by circumstances beyond Contractor's control, the work delays that are not avoidable by the Contra (date). The Owner hereby acknowiedges and ayrecs that the scheduling dates are approximate and that such ctor Shall not be considered as violations of this Agreement. O P4 O U W O W O � W AJ Walsh & Sons Inc. 55 Picasunl SIrccl NhIss. HC'IiNSI d 022680 Norlll Andover, MA 01845 llstss. IZ a;ISl'IZ: YlON # 10.3.3.58 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged In home Improvement contracting, unlessspeclficaliv exempt from registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth of !Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: Registration Number: Salesperson's Name: This agreement is made on (D TE) of (ADDRL•SS) hereinafter called "Contractors",and of (ADDRESS) hereinafter called "Owner". DETAILED DESCRIPTION OF WORK 7'0 BE PERFORMED ContRctor agrees to pe(for%in a good and workinanlikSinanner all work DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials tobeb-e us in orming a above described work consist of the fol (OWNMR) (COMRACTOR) / (PIiONF NUMBER) 7f— -- S-; (PttONE NUMBER) helow. Such w,a k consists of the G (L,.., 11. PRICE 1W Contractor agrees to do all work described in Section I for the total price of S/ ®V W. PAYMENT Payment will be made as follows: 1% 90�$ -mss sem^ upon signing Contract; %(s I %OG • 7_ —� _) upon completion of upon completion of and the remaining 4'0$ tJ(i - -- arulContractor ashavutgbeetisatis�ycmpl ted,whchverificati nverifcation f the worksh ll take Place promptly after completion. Notice: No agreement for home Improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, In advance, to order and/or otherwise obtain delivery of special order materials and equipment, erecter whichever amount is IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order thjmaterials before the third day following the signing of this Agreement unless specified here in writing. Contractor wij) begin tit work ott oLa�out `� T %J�-D`j will be completed by - {- �l ._(date). Barring delay caused by circumstances beyond Contractor's control, the work delays that are not avoidable by the Contra (date). The Owner hereby acknowiedges and ayrecs that the scheduling dates are approximate and that such ctor Shall not be considered as violations of this Agreement. A.J. Walsh & Sons Inc. 55 11Icasaill SIrccl North Andovcr, MA 01,945 (\lass. LICENSI d 022690 Mass. ItI a i1S 1 12,11 1u� n 10.3.358 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home Improvement contractors and subcontractors engaged Inborne Improvement contracting, unless specincally exempt from registration byprovislonsof Chapter 142a of the general laws, must be registered with the Commonwealth .or Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. This agreement is Designated Registrant's Name: Registration Number: Salesperson's Name: (?,13 0' (ADDRESS) hereinafter called "Contractor" and (OWNER) (ADDRESS) hereinafter called "Owner'.. DETAILED DESCRIPTION OF WORK TO BE PERFORMED ContcWr agrees to pe�rfo in a go(xl and wotkmanlikc iann( all work (etailed lxlow. ;ucl) DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be us in orming a abov described work consist of � A h - , mil'/, . U. PRICE Contractor agrees to do all work described in Section I for the total price of S_ W. PAYMENT Payment will be made as follows: (CONntACTOR) . / (P'tONP. NUMBER) (P'roNE NtnaeF�q consists of the folio �? 1C•1 % upon signing Contract; a�U upon completion of upon completion of and the remaining �o (g 06 ") upon verification of the work by Owner and Contractor as having beet' satisfactorily completed. which verification shall take Place promptly after completion. Notice: No agreement for home Improvement contracting work shall require a down payment (advance deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make, In advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount t erecter• IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order k ut th Contractor will begin th� materials before the third day following the signing of this Agreement, unless specified here in writing. woroft oca `� -'- 13-0-3will be completed by -—�(date). 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