HomeMy WebLinkAboutMiscellaneous - 35 PUTNAM ROAD 4/30/2018Ar
Date.... .........................
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
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This certifies that ...................................................................................... .............l.!_'.
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has permission for gas installation
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in the buildings of ...................................................
...... ................ North Andover, Mass.
......... .... ........
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Fee.66..= Lic. No. GAS INSPECTOR
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04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02
A ® DATE (MM[DDNYYY)
�.-- • CERTIFICATE OF LIABILITY INSUNCE page 1 Of 1 08
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THIS CERTIFICATE IS ISSUED ASA 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 8Y 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.
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IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the Polioy(ies)murt 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).
williq of Massachusetts, Inc.
c/o 26 CoAtury Blvd.
P. 0. Box 305191
Nashville, TN 37230-5191
R. H. White Construction Company, Inc.
41 Central Street
P. 0. Box 257
Auburn, MA 01501
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INSURERS AFFORDING COVERAGE NAICe
INSURERA: The CAArtGr Oak rirA Insurance Company 25615-001
INSURERS:Travol* E2 Property Casualty COApany oi' Am 25674-009
INSURERC:NatiOnAl Union Fire Tnsuranao Company o£ 7.9445-001
INSURERD;Travelers Ind&=r ty Company 25658-DOl
INSURER F.;
"'-" t r-KlNUMIShIt:20287680
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER I
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMI7S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPEOP INSURANCE
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POLICY NUMBER
GENERAL
LIABILITY
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VTC2000 977RD940-13
X
COMMERCIAL GENERALLIASILITY
CLAIMS -MADE OCCUR
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PERSONAL&ADV INJURY $
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GENERAL AGGREGATE $
4, 000 000
PRODUCTS-COMPIOPAGG $
GEN'LAGGREGATF LIMITAPPLIES PER;
POLICY PRO LOC
OMBINEDSINGLFLIMIT $
acoldent
2� 000, 000
AUTOMOBILE LIABILITY
BODILY INJURY(Peraccident) $
VT,7CAP 977K955A-13
X ANY AUTO
$
ALI.OWNED SCHEDULED
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AGGREGATE
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L_54 000, 000
AUTOS AUTOS
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MAA
UMBRELLALIAB X OCCUR
B387661.40
X EXCESS LIRE CLAIMS -MADE
DED I $ RETENTIONS 10,000
WORI(ERSCOMPENSATION
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AND EMPLOYERS' LIABILITY YN
ANY PROPRIETORIPARTNFRIFXECUTIVEI :l
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VTC2XUB 8203A71A-13 <
OFFICER/MEMSl REXCLUDW? Lam" JJ
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Myyendatoaln NH)
ULVliKill I IUN tiF OftRATIONS
below
:RIPTION OF OIDr.�AT1l1LIC / I f1r'.w nnue ..ranw.
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,/1/2013 9/1/2014
3/1/2013 9/1/2014
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•.•-••-,•-•,•---.p...m„nw,u-,ut.Noa,mnPl mernarxa SOhotlUIN, Ir More epga&
EvidOnce of Inmurance
:D NAMED ABOVE FOR THE POLICY PERIOD
IOCUMENT WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT TO ALL
THE TERMS,
LIMITS
EACN OCOURRENOE F-
2, 0 0 0, (LCL
r�ETO RENTF,p
,SEB [Ee ocel,rencr) $
-
3 0 0_ g 0
MED EXP (Anyone personJ.R
10_ 000
PERSONAL&ADV INJURY $
2 OOQ,OOO
GENERAL AGGREGATE $
4, 000 000
PRODUCTS-COMPIOPAGG $
J,.000 000
Is
OMBINEDSINGLFLIMIT $
acoldent
2� 000, 000
BODILY INJURY(Perpereon) S
BODILY INJURY(Peraccident) $
9raccldent $
$
EACHOCCURRENCE L__5_10
000
AGGREGATE
_0_01
L_54 000, 000
5
x rARa:u ° -
E.L.EACH ACCIDENT
1, 000 000
E.L.13I8EASE-EAEMPLOYP.E S
1,000,000
F,L,DISEASE. POLICY LIMIT $
1,000,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
C011:4197604 Tp1:1694012 Ce7:'t:20287680 ®1988-2010ACORD CORPORATION. All rights reserved .
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
.--.
(Print w Type)
NORTH ANDOVER, Maas, Date '" 105
5
Bugding l-J0,11la? A, e cy
Permit �
Location . 3 S Put h am�-
Owner'a
Name A all el S %7 ,'d d
New p Renovation p Replacement Plans Submitted: Yes ❑ No
FIXTURES
Check one:
Installing Company Name Ilhll e fvcG P. r P b corp.
Address &)( 92 g ❑ Partnership
'h� a
/JO /�I1dovei- v ❑ Firm/Co.
Business Telephone 775-
Name
75-Name of Ucensed Plumber 8 S 47 QO b e r� b j an CI O# A.
INSURANCE COVERAGE: ec one
I have a current Ilabllty Insurance policy or Its substantial equivalent, Yes (�' No ❑
If you have checked jM, please Wicale the type coverage by checking the appropriate box
A Ilablity hn:urance policy V • Other type of Indemnity ❑ Bond ❑
Certincate
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General laws, and that my signature on this permit application waives this requirement.
Check one:
§Fnatute of Owner or owner a Aceni Owner p Agent ❑
I hereby pertly that all of the details and information 1 have submitted for entered) in above application are true and &=#&to to the best of my
knowledge and that all plumbing work and Installations performed under the p rmit Issued for this application will be In compliance with all
pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter i42 of the General Lowe
ArTFK WED (OFFICE USE ONLY)
gna ure of se um er
License Number
Type of Plumbing License: Master ❑
Journeyman ❑
Date .............
"O RT :��a
TOWN OF N i711 ANDOVER
? ,. �, _.., •, C
AL
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PERMIT F� OLUMBING
�,ssACHU
CIO
This certifies that ...........
t:.............. ��....... .
L�
has to
permission perform ..
.`........ .................
plumbing in the buildings of
............. ..............
at 0..........,.-...:
f
r Andover, Mass.
....
. ..... ,North
Fee....... Lic. No......
,.! �.............................
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building
Dept. PINK: Treasurer GOLD: File
Location
,,Q�
No. i �0 % Date
NORTH TOWN OF NORTH ANDOVER
p Certificate of Occupancy $
41
° ,,• .
Building/Frame Permit Fee $� J
Foundation Permit Fee $
s�CHU
-Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
NOV I TOTAL $ 57
Building Inspector
6681 Div. Public Works
OPER"m NO.
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
/PAGE 1
MAP 4-40.
LOT NO.
I
2 RECORD OF OWNERSHIP IDATE
BOOK 'PAGE'
ZONE
SUB DIV. LOT NO.
LOCATION L A, i►,A
'VTiil
PURPOSE OF BUILDING
OWNER'S NAME E
NO. OF STORIES SIZE
OWNER'S ADDRESS 3 S jf�li N e4 m(d
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS 1ST 2ND
3RD
BUILDER'S NAME
DISTANCE TO NEAREST BUILDING
Aw /_1Z_O__0IF Vt.)vi hj d%A-3 t - .� �,j
GY ,QLIi�L 1My�
DISTANCE FROM STREET
_ W//JI?W !/ #-
0
DISTANCE FROM LOT LINES - SIDES REAR
" SIRBERS 4-P„
l�•l' vt!"
i�iV'C7
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
A:7 PAGE 2 FILL OUT SECTIONS 1 - 12
' ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND GA�PPROVED BY BUILDING INSPECTOR
DATE FILED - wh /` -
SIGNAl%AE 3F OWNER OR AUTHORIZED AGENT
06
FEE U
PERMIT GRANTEIr OWNER TEL. #--(p 99108/
CONTR. TEL. # ?5• Z2 Z
1st_ CONTR. LIC. #�_ 1 7(o el
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST C/a/ 000 # 00
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
1
OCCUPANCY
SINGLE FAMILY
WOOD JOIST
S_ PIES
MULTI. FAMILY
_
OFFICES
APARTMENTS
TIMBER BMS. 6 COLS.
_
STEAM
CONSTRUCTION
2 FOUNDATION
HOT W'T'R OR VAPOR
8 INTERIOR FINISH
CONCRETE
_
3
I
2 13
CONCRETE BL'K.
RADIANT H'T'G
PINE
UNIT HEATERS
GAS
BRICK OR STONE
OIL
HARDW D
ELECTRIC
NO HEATING
PIERS
PLASTER
_
DRY WALL
3 BASEMENT
UNFIN.
AREA FULL
FIN. B M'T' AREA _
'/. 1/2 l/.
FIN. ATTIC AREA _
NO SMT
FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WAILS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDW D _
ASBESTOS SIDING _ COMMON
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
5 ROOF 11 10 PLUMBING
BUILDING RECORD
12
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. 6 COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
GAS
7 NO. OF ROOMS
OIL
B'M'T 2nd _
lsI 13rd
ELECTRIC
NO HEATING
.
~1-508- 975-12221
s
"/ X123 North. Street' Andover, Mass,,r 018'1'0,4 =
°
Massi F,Hb a improvement ,Contr'attor Regi strati on,*105393
,,
F h1t�%31
Marianne
Hol 1'i`ngshead r mob`,
<9.3
. 35 , P'utna'm Road b88- 10E31 t,
Nor=th :AndDv, er,., ,V18 5, �Kitchen* ,.
,.Mass: ,Bat'h
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.,.....�3._���}L�f'1's ,4,'.!•:....at«".: , a,._' r; .. , t• .
inc lodea.
,Remove existing cabinets,and 4'nstal1..new
,Instal l new counter.'tops•-
Remove ,existing w ndow,' and...: i nsta11 new
Bath Room''
:Incl udes:
,' -: • g: Butt tout, room , complete, ,: '
g Install new wr. sheets rbc;k
,Install new window• sashes onI y
+.
... t .
Instal l- new ,wood trim,-.,
;a n
WEr FROPpSEherebyto furnish -materials and I abar' -- complete r
. in:•accordanc•e wi.tti:the•attiove.spedif. cations, .-For ;the sum of:
.Ten thozusand dollars f 10, �00 00
't,o'
Payment be ::made -•as fol lows:x •>. ' '
-Authorized signature-{r��. - - ---- - .
;This proposal may be ,withdrawn ,�y= us •,-i f =not -accepted-within
-t- 10, days--------- !
Signature --' ------ -=-.------ t
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CERTIFICATE OF USE & OCCUPANCY
Towyn of North Andover
6
Building Permit Number.
507
THIS CERTIFIES THAT
Date DECEMBER 10, 1993
THE BUILDING LOCATED ON 35 PUTNAM ROAD
MAY BE OCCUPIED AS RENOVATIONS TO KITCHEN & BATHROOM IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO Dale Hollingshead
35 Putnam rd.
ADDRESS North Andover, MA
Building Inspector
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Location ��� U�.•��-�--�
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee -$
Foundation Permit Fee $
Other Permit Fee $ �� U
Sewer Connection Fee $
1A& Connection Fee $
2.6 TOTAL
Building Inspector
r 4
6668
Div. Public Works
PERI(rr NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
{J
/PAGE 1
MAP 4-40.
LOT NO.
2 RECORD OF OWNERSHIP iDATE BOOK ;PAGE
ZONE
SUB DIV. LOT NO.
LOCATION
PURPOSE OF BUILDING
OWNER'S NAME
NO. OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME
4.4 f
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES — SIDES REAR
" GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED 119,3 Q,3
PERMIT GRANTED
19
OWNER TEL. # 1 1,614'�
COiJTR, TEL. #�
CO'JTR. LIC. # b& 5/eP�/%
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
_ � A
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
c
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
I S.-ORIES
MULTI. FAMILY
OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
S INTERIOR FINISH
CONCRETE
PINE
3
1
2 13
CONCRETE BL K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B M AREA
_
1/4 1/7
FIN. ATTIC AREA
NO B M
FIRE PLACES
_
_
HEAD ROOM
MODERN KITCHEN
4 WALLS I
9 FLOORS
CLAPBOARDS
CONCRETE
EARTH
HARDIVD
COMIACN
ASPH. TILE
B
1
2
�_
3
_
_
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASUN'RY
BRICK ON FRAME
ATTIC STRS. & FLOOR _
CONC. OR CINDER ELK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I_�POOR _
ADEQUATE NONE
10 PLUMBING
5 ROOF
GABLE—
HIP
BATH 13 FIX.)
GAMBREL
MANSARD
TOILET RM. (2 FIX.)
_
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
_
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
_
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. d COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 2nd _
lit 13rd I
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
oll
L�
OFFICES OF: Tow .df.
APPEALS ;t NORTH ANDOVER
BUILDING t;'� Ma►;e
CONSERVATION DIVISION OF
.
HEALTH
PLANNING PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECTOR
120 Main Street
North Andover.
Massachusetts O 184-5
(617) 6854775
r 'I-
1.
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number ,�O a— 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 111, S
150A -
The debris will be disposed of in:
(Location of .Facility)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
Castricone Roofing & Siding
REPAIRS FREE ESTIMATES
Telephone: (508) 682-4266
MARIO CASTRICONE
61 Water Street, No. Andover, Massachusetts 01845
6gg��g�
I/we, the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish
all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following
specifications, term and conditions, on premises below desc 'bed:
Owner's Name ,:... ....
�C_.�..
Job Address
...... ...... .......................................City . .. ...t&`�7
State ........ .. ..............
SPECIFICATIONS
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Materials and labor to cost f�
$........................................... Payable ........................ on ... ...... and balance in ................
n-:enthly installments of $ .................... each, payable on ........................ day of each and every month thereafter until paid
in full ( ............ % charge per year is to be added to above cost of labor and materials and is included in monthly payments.)
Contractor will do all of said work in a good workmanlike manner.
Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accord-
ance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor
may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is
agreed that if permitted by law contractor shall be paid by the owner(s), all reasonable costs attorney fees and expenses,
in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract
and/or any lien in connection therewith.
It is further agreed.that this contract may be assigned by contractor; and also that the obligations hereof shall bind
and apply to their heirs, successors or estates of the parties.
The undersigned warrant (s) that he is ( they are) the owner(s) of the above mentioned premises and that legal title
thereto stands of record in his ( their) name(s).
PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused.
There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any
agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any sub-
sequent agreement in reference hereto shall be binding only if in writing and signed by all parties.
Receipt of a copy of this contract is hereby acknowledged, and it is further acknowledged by the undersigned that the
foregoing provisions have been read and the contents thereof understood and that no representation or agreement not here-
in contained shall be binding upon the parties and that all of the agreements and understandings of said parties are con-
tained herein.
Owner or Owners are not responsible for Property Damage or Liability while job is in ope tIgr `ni
IN WITNESS WHEREOF, the parties have hereunto signed their names this .. .. r:L•.. day Of
:....., 19..J
Accepted:
(OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Signed ... 1 ..... Q„a&�
Owner
Per44��............................
Representative
Signed ............................
Owner
Signed......................................................................................
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that *V.�
r �
has permission to perform ... It. t ! ............. %.l.. .
plumbing in the buildings of J. *;/....................
at ...) .?�.. �� s . ..�� .4 .�............... �, .. , North Andover, Mass.
I r�
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Fee.S°Lic. No..�.r....... /....... .-N........
?LUMBING INSPECTOR
Check # /V c
5512
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
\ Date � 3
Building Location �j PUVA) Owners Name OPV fJ Permit # S �2
q�L, Hrnoum 4-1 6 —
Type of Occupancy / (L � / ;• T/�.
New rl Renovation Replacement 1:1 Plans Submitted Yes ❑ No ❑
(Print or type)
Installing Company Name
Address
usmess
Check one: Certificate
E Corp.
Partner.
Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑
I hereby certify that all of the details and information I
best of my knowledge and that all plumbing work and
compliance with all pertinent provisions of the Mass
(APPROVED (OMCE USE ONLY
Agent n
entered) in above application are true and accurate to the
ied under Permit Issued for this application will be in
1&�;cade and Chapter 142 of the General Laws.
'I'ff f Plumbing License
cense INUMDer Master ❑ Journeyman j j�
1'
i
.J
----------------
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------
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(Print or type)
Installing Company Name
Address
usmess
Check one: Certificate
E Corp.
Partner.
Firm/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity ❑ Bond ❑
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑
I hereby certify that all of the details and information I
best of my knowledge and that all plumbing work and
compliance with all pertinent provisions of the Mass
(APPROVED (OMCE USE ONLY
Agent n
entered) in above application are true and accurate to the
ied under Permit Issued for this application will be in
1&�;cade and Chapter 142 of the General Laws.
'I'ff f Plumbing License
cense INUMDer Master ❑ Journeyman j j�