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Miscellaneous - 36 ANDOVER STREET 4/30/2018 (3)
N Blank Thiels North Andover Board of Assessors Public Access Page 1 of 1 f � , E ,&ORTIf.a" O t��ao yWO F A t .►' n ,SSACHU`�� Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial North Andover Board of Assessors roperty Record Card Parcel ID :210/059.0-0024-0000.0 FY:2013 Community: North Andover xation: 36 ANDOVER STREET wrier Name: MACON, GLEN MACON, ANTONIA wner Address: 36 ANDOVER STREET City: NORTH ANDOVER State: MA Zip: 01845 eighborhood: 6 - 6 Land Area: 1.49 acres se Code: 101-SNGL-FAM-RES Total Finished Area: 3699 soft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 581,000 548,700 Building Value: 368,700 338,100 Land Value: 212,300 210,600 Market Land Value: 212,300 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2253840&town=NandoverPubAcc 3/26/2013 Blank Thiels 1 o� os 00, 00 r 0 00� MCO _ C1 01 „ to Cl) r r . tt3 N N vco CL o C C co 4d r11 a. a) 0 m hia� SZ (O� 3�N •• e O fA !a p Q. 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N��M} N �O -1 z LuI Q cD D a (9Q >Z OzzQQ� 0 N n0 -'CL to cQ _W N 6 U 2O Co'a cF-�aig Cu ?Ip" 3: v`o mz>ouQ �cuo3 '(L)i 0 Q n n'0W 2 LL M LL, LL!U a H ca a MetLife Auto & Home° Homeowner Operations Field Claim Office Attention: Claims P.O. Box 6040 Scranton, PA 18505 (800) 854-6011 Rmt A n n- I * March 2, 2015 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: Glen and Antonia Macon Claim Number: JDE92755 OG Date of Loss: February 12, 2015 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 36 Andover St, North Andover, MA Sincerely, Home Ops CAT Team Sarah Lackey Metropolitan Property and Casualty Insurance Company Claim Adjuster (800) 854-6011 Ext. 7440 Fax: (855) 411-6689 Email: MetLifeCatTeam@metlife.com MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates, Warwick, RI. MPL MA-REGDEPT Printed in U.S.A 0698 Date ...Z..`.ZF:: e.7.. HORTf{ "°0 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 4 • ,' ,SSACMUS� This certifies that ........,/ V.....:....................._................................................. has permission to perform............. ......................................... ............ wiring in the building of / ! q-G0�2/ ................................................................................... at ......... 2.5 ?.... fly. .f.......5/........ , North Andover, Mass. ! Fee..,,,,�J,��.:�... Lic. No.V0.1.......... '1...... .. LECTRICALINSPECTOR V Check # d Q� 79'13 Blank Thiels f IQ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 17,76 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR00 (PLEASE PRINT IN INK OR TYPE ALL INFORAM TION) Date: 2 Z 1 .0 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), Owner or Tenant �� �„�� t I eY` Yy►a Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building R -C S t`Utility Authorization No. Existing Service Amps / Volts New Service Z, Amps &0 /zYO Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead 0- Undgrd ❑ No. of Meters Overhead ❑ Undgrd �- No. of Meters - r bb I� -LILA- Servi?-e COm letion o tl Il L Hrracn additional detail y desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: . 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 lJ2�-�OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:Iva yototie— t G°Gr{7` LIC. NO.: M 6 C( Licensee: 6t -e -p .e� NeroLoye Signature LIC. NO.:AII (if applicable, enter 'exempt" in the license numbr line.) Address: !O (5 t,tJ, >Rr <n -k9- S PS !gky--ee,�t Bus. Tel. No.,• Alt. Tel. No.: 7,V/- f3 *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 Signature Telephone No. PERMIT FEE. $ 0 owin to e m be waived b the inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ No.—Of Emergency 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 of Detection and Initiatin Devices No. of Ranges No. of Air Cond. TotTons No. of Alerting Devices No. of Waste Disposers Heat Pump Number ITons .KW.. No. ofSelf-Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances K`,l, Security Systems:* No. No. o Water No.KW No. of of Devices or Equivalent Data Wiring: Ballasts Si ns Balasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Z I G 1I,c, Hrracn additional detail y desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: . 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 lJ2�-�OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:Iva yototie— t G°Gr{7` LIC. NO.: M 6 C( Licensee: 6t -e -p .e� NeroLoye Signature LIC. NO.:AII (if applicable, enter 'exempt" in the license numbr line.) Address: !O (5 t,tJ, >Rr <n -k9- S PS !gky--ee,�t Bus. Tel. No.,• Alt. Tel. No.: 7,V/- f3 *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 Signature Telephone No. PERMIT FEE. $ Blank Thiels Date ...........a`.�..... ?..... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that UJ '"}�1i1 6L, has permission to perform ...%. wiring in the building of ....................................................... atm k.......... �.................................... .North Andover, Mass. aw Fee. 3 :`._....�.... Lic. No.�`�:............................... �l ELECCRICAL�IiWF EcrOR + Check # 7345 Blank Thiels 150 •a Commonwealth of Massachusetts OfficialUse only 18 Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11 /991 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: City or Town of: J(/• JN PVY % 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 & R "Q,06yc s T'• Owner or Tenant al- L,5ti M,4 60AI Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building /Z &S/,0Z-,yb'N L 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: 12- E In Q c/ 4— A / 7-c- PiE& X 010 / -�/D 7111 Completion o the ollowin table maybe waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA INo. of Lighting Fixtures Swimming Pool Abov E] [n-rnd. El o. o ncy ig ing rod.c Batte 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 I No. of Waste Disposers Heat Pum umber - - " — Tons -' KW - No. of Self -Contained Totals Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ un echo ❑Other Connection No. of Dryers Heating Appliances Key Security Systems: No. of Devices or Equivalent No. of Water, No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Hydromassage Bathtubs No. of Motors Total HP o firing: icationNo. a ecommunv Devices No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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 cFIBONDE] ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Workf/;L O -D (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: Ie&-, /Lie, LIC. NO.: Licensee: Roes r (�q. /LJlN/C 1 I/b Signatu LIC. NO.: AIZ132, (lfapplicable. enter "exempt" in the license number line.) Bus. Tel. No.: Address: �- 35 3 /77APZ Sf' k-5 A9 / /.f -7 Alt. Tel. No.:V- /`f,ZD -971/ OWNER'S INSURANCE WAIVER: 1 am aware that the License6 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 ❑ owners agent. Owner/AgentPERMIT FEE: S —Sr C' Signature Telephone No. � Blank Thiels Date.. ..� L�Q.7..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .....P' . �.... r.�� •.K.. �.............. has permission for gas installation ................... in the buildings of .///.A/.n., ............................ at ............ . . North Andover, Mass. Fee. Lic. No... ...... GAS INSPECTOR Check # 6069 Blank Thiels r V MASSACHUSETTS UNIFORM APPUCATON FOR PERM TO DO GAS FITTING (Type or print) /� Date NORTH ANDOVER, MASSACHUSETTS yf Building Locations Permit # Amount $ Owner's Name v4 �4 New D Renovation D Replacement LJ Plans Submitted D G SU B-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. 4TH. FLOOR FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. 8TH. FLOOR FLOOR (Print or type) Name_ Address A y— ` Business Te ep one q 0 Name of Licensed Plumber or Gas Fitter CM k one: Certificate Installing Company Corp. .� Partner. irm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No 13 If you have checked Les, please indi the type coverage by checking the appropriate box. Liability insurance policy � Other type of indemnity 13 Bond 13 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: Signature of Owner or Owner's Agent Owner 0 Agent ri I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permi ssued for this application will be in compliance with all pertinent provisions of the Massac�s SGas Code aAChapt�42 of ft General Laws. IBy: ity/Town I (APPROVED (OFFICE USE ONLY) v w- S' ature of Licensed Plumber Or Gas Fitter. Plumber Gas Fitter License Number Master 13 Journeyman o Z i- c > > W W F W Z7 F ZF Z W W (7 LT. U w> a d N m z z N o Address A y— ` Business Te ep one q 0 Name of Licensed Plumber or Gas Fitter CM k one: Certificate Installing Company Corp. .� Partner. irm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No 13 If you have checked Les, please indi the type coverage by checking the appropriate box. Liability insurance policy � Other type of indemnity 13 Bond 13 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: Signature of Owner or Owner's Agent Owner 0 Agent ri I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permi ssued for this application will be in compliance with all pertinent provisions of the Massac�s SGas Code aAChapt�42 of ft General Laws. IBy: ity/Town I (APPROVED (OFFICE USE ONLY) v w- S' ature of Licensed Plumber Or Gas Fitter. Plumber Gas Fitter License Number Master 13 Journeyman Blank Thiels Date ... 6 . zz...4.7 ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........-? o..............`:�:r........ U has permission to perform ...` ......................'? .......................... wiringin thepuilding of................................................................................... 12c/ at .......:........-............................... ...:............. ,North dover, Mass. Fee L'...s�......... Lic. No "'� � �•••..j:1 .... �....................... ELEGT�ICAL IryarnCTOR Check #�G�` j 1///// 7453 Blank Thiels 4 _ I tie tiommonwealm of Massachusetts Permit b. Department of Public Safety �- — + Uccupancy S For Checked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 Cleave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All nark to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORUMON) Date City or Town of To the Inspector of Wires: The undersigned applies for a z - -w . -_, 1the electrical work described below. Location (Street & "Number) 1,/., JT'I�IUU`A'� S"-- 0- d_,t&6-x_ A4- o G d -LS �r or Tenant G � U, Owner's Address 4Lft'i1%.e _• Is this permit in conjunction with a building permit: Yes ® No ❑ (Check Appropriate Box) Purpose of Building // C Utility Auth:,rizacion NO. Existing Service Amps J / �� olts Overhead �. Undgrd ❑ No. of Yzters_� New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of deters Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work No. of Lighting Outlets INo. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. grnd. Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑ Other Connection No. of Ranges Total No. of Air Cond. tons No. of Disposals Heat Total Total No. of p=os Tons KW No. of Dishwashers (Space/Area Heating KW No. of Dryers IHeacing Devices KW No. of Water Heaters L_W No. of Sifnsf Ballasts Low Wirinoltage No. Hydro Massage Tubs No. of Motors Total HP OTHER: 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 C] I have submitted valid proof of same to this office. YES QG NO Cl If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE -BOND ❑ OTHER ❑ (Please Specify) Expiration —Date) Estimated Value of Electrical Work S 1/J _i Work to Start �Inspection Date Requested: Rough t'` Final Signed and the penalties of perjury: po � FIRM NA J IG LIC. NO. _) L Licensee \11' �U Signature LIC. NO. C9e3g� Address—&I Bus. Tel. No. F3 as Alt. Tel. No. OWNER'S INS CE WAIVER: i am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit t application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S S� Signature of Owner or Agent) Blank Thiels f NORTH, TOWN OF ORTH ANDOVER O ,.�o O t PERMI -O PLUMBING ONUSfc� This certifies that ..(. .............. .................. . has permission to perform . ..._ -'T �.4-�................ . plumbing in the bui-lldings of....�.......'.�'.................. . at. fir.... (-� .- ........ North Andover, Mass. � n ' Fee .'1. /...... Lic. No.,fv.� ' PLU 1N IINSPECTOR Check # y 7363 Blank Thiels �— 6Qa 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS I n Date � _ � 7 � Building Location 3co A l� d 0�SC. ' Owners Name �` �L�ti � C�� Permit # p cy �S I� e11 f 2 I Amount T e of Occu an Newt Renovation Replacement Plans Submitted Yes No FIXTURES (Print or type)/� J 11 y ke6,jVQCheck one:Certificate Installing Company Nam1�Gn � U bt J Corp. Address 6D7- C s T Partner. Business Telephone Firm/Co. Name ofLicensed Plumber. Insurance Coverage: Indicate type of 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 threeinsurance ignature Owner Agent I hereby certify that all of the details and information I have su 'tted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and in ations ed Permit Issued for this application will be in compliance with all pertinent provisions of the Massac S mbin�epter 142 of the General Laws. By igna icens um er Type of Plumbing License Title ��-�- City/Town icense um er Masten Journeyman ❑ J(` APPROVED (OFFICE USE ONLY Blank Thiels Date... .��U�.... ,eye pL OWN OF NORTH ANDOVER ldsalkr� 11% • PERMIT FOR GAS INSTALLATION This certifies that p!�, �! ---^J. ,.. �`? .A.4 .............. has permission for gas installation in the buildings of ... . y. `........... ................... . l at --e ..e ..... .... , North Andover, Mass. Fed—.,A? Lic. No.!?c?.�,�.. /�...'........... % t GAS IVSPECTOR Check # 5974 Blank Thiels MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) . . NORTH ANDOVER, MASSACHUSETTS Date % —/ ? —d Building Locations 3��.��Q 111 1% S 1 Permit # Amount $ Owner's Name -I Y l � CG New�Q Renovation Replacement 1:1 Plans Submitted rl (Print or/tyy pe),+L� Ch k one: Certificate Installing Company ��J L, Name LS C�Y� Corp. Address La I LA /C(" S 7-- El Partner. w Business 11elephone p --c5Cj> 0 7 Finn/Co. Name of Licensed Plumber or Gas Fitter L INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes 13 No13 If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy jzj-1 Other type of indemnity ID Bond 13 Owner's Insurance Waiver: 1 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: Signature of Owner or Owner's Agent Owner 0 Agent 13 I hereby certify that all of the details and information I have submi entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installs • ns perfo a nder rmit Issued for this application will be in compliance with all pertinent provisions of the Massachu s State 9antyferM?yof the General Laws. .7 . Title (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber /5`Ga-2 Gas Fitter LicenseNumber Master Journeyman � v1 O4 v1 � � zza OG F a W W a °� F w p 6 p z � a F w x w � � w � ae � z w F a F a 4 > e Z d W C Q x F' E.W. a +`� V O > Gn IW. F U W W W > W ar z e C e d O O w O vFi x SUB -BASEMENT x O x 3 a t7 .a v a > a a H O BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or/tyy pe),+L� Ch k one: Certificate Installing Company ��J L, Name LS C�Y� Corp. Address La I LA /C(" S 7-- El Partner. w Business 11elephone p --c5Cj> 0 7 Finn/Co. Name of Licensed Plumber or Gas Fitter L INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes 13 No13 If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy jzj-1 Other type of indemnity ID Bond 13 Owner's Insurance Waiver: 1 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: Signature of Owner or Owner's Agent Owner 0 Agent 13 I hereby certify that all of the details and information I have submi entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installs • ns perfo a nder rmit Issued for this application will be in compliance with all pertinent provisions of the Massachu s State 9antyferM?yof the General Laws. .7 . Title (APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber /5`Ga-2 Gas Fitter LicenseNumber Master Journeyman Blank Thiels permit N0: �/ Date Issued: ' 4 "6 LOCA PROPERTY OWN TOWN OF NORTH ANDOVER NORTH Of t,i,_6° 06 PLAN EXAMINATION APPLICATION FOR 3? 4•,. ; 6 0� ' 0 � Datg Received 00CATI Cl '� °, �•� K• '' 11 ®e tr,o ,SSAC IMPORTANT: MAPNO.: EL: ----- icant must Print Print ZONING DISTRICT: on this HISTORIC DISTRICT TYPE AND USE OF BUILDING PROPOSED USE TYPE OF IMPROVEMENT Residential ❑ One family ❑ New Building ❑ Two or more family V4ddition No. of units: ❑ Alteration ❑ Assessory Bldg ❑ Repair, replacement .Demolition 0'4- ❑ Other ❑ Movin (relocation) ❑ Foundation onl DESCRIPTION RMED OF WORKTO Bc P �F�, _21Le_- *4__ OWNER: Name: Address: CONTRACTOR Name: CIIIIII17� d r% Identification Please Type or Print Clearly) YES Non- Residential ❑ Industrial ❑ Commercial ❑ Others: R Address: E xp. Date: ���� Supervisor's Construction License: 7 S41'7_Exp. Date: Home Improvement License: % � � / 1 �J Name: Phone: ARCHITECT/ENGINEER )OVReg. No. Address: • 2.00 PER $1000.00 OF THE TOTAL ESTIMATED COST ON $125.00 PER S.F. FEE SCHEDULE: BULDING PERMIT. $1 O'l FEE:$ 7© Total Project Cost :$ V �� Receipt No.: Check No.: Page Iof4 Location s T o -e-, No. 0 Date "ORT" TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ CMUEta Buildirig/Frame Permit Fee $ �S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # q,2 19835 G----_ �� Building Inspector t YPE OF SEWERAGE DISPOSAL Public Sewer 211, Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Tobacco Sales ❑ Permanent Dumpster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ U; rersonN contractin wim u istered contractors deo not have access to the guarantyfund Signature of Agent/Owner `signature of contractor Plans Submitted Plans ived ❑ Certified Plot Plan Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS Q DATE APPROVED D )REJECTED DATE APPROVED kCONSERVATION COMMENTS S j � t°��tTIVI/l1 i fy-)l HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ ME DEPARTMENT - Temp Dumpster on site yes no Eire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer ConneCtiOn/Sienature & Date Drivewav Permit 0O z • 0�, O tw"60 :T E Z CA CD CD O cc H 0 .y O V O C cc (A 0 H Z � a 3� O of o a CL cma c .o cc c 'v 0 CD Z s CDCL C W 0 U) ul U) �C W 19 W N o N O o Nk. a c y 0 a V V p, C W W m c Z O O � Z E a w c M me .. o a N E c Q R� w cn chi ,� w° a�' as r. U w w E 'xg0 mC w 0 pG w rA cn cn O tw"60 :T E Z CA CD CD O cc H 0 .y O V O C cc (A 0 H Z � a 3� O of o a CL cma c .o cc c 'v 0 CD Z s CDCL C W 0 U) ul U) �C W 19 W N N O o Nk. c y 0 V V p, C W W m c Z O O � Z E a w c M me .. o a N E c o 40 ts cp �y� E mC 0 y 3 H c m Go °O M9 H O N m O ro c m qao � CD C C O Q ID O m C3 Z co o c► C CL c = m :m3 � $ �m0o� m y Ire i- to COwOC = n m� o 5 CO _m Go .0 =a o CLS CA 51. O tw"60 :T E Z CA CD CD O cc H 0 .y O V O C cc (A 0 H Z � a 3� O of o a CL cma c .o cc c 'v 0 CD Z s CDCL C W 0 U) ul U) �C W 19 W N Blank Thiels B-D0E-B%ft1I9G`&&&0r License: Number: CS 083917 Birthdate: 06/28/1957 Expires: 06/28/2006 Tr, no: 83917 Restricted: 00 WILLIAM H POGOR 79 JOHNSON STS NO ANDOVER, MA 01845 { Administrator , .F ,•"�lnrpd 10140t!urPtt 091.0 t%W `?]3AOOt+N H12iON F 19 NOSNH2(, 6L � 090d YWI!r fr a— t lenpu LOOZ�� ' - ���)113i13AC13WQH - itE1 i SWUPP ue saogejn fag $ntPlt�B 3o W �- 1 , . i Blank Thiels The Commonwealth of Massachusetts I % I Department of Industrial Accidents Office of Investigations M I 't' ° 600 Washington Street N i Boston, MA 02111 t s- www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 11111A,2;V � �tlZ,6y G - Address: /,�) City/State/Zip: Phone #: �'�� �%6 �� 76 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4..iq I am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).* 2. Fl I am a sole proprietor or partner - have hired the sub -contractors listed on the attached sheet. t] Remodeling ship and have no employees These sub -contractors have 8. Demolition .working for me in any capacity. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 9. Building addition [No workers' comp. required.] officers have exercised their 10.❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box # I must also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #:� ��/ Expiration Date: /-/-3-67 Job Site Address:_ 36City/State/Zip: ff 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. / do hereby cert/under the pyre and penalties of perjury that the information provided above is trite and correct. 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. Citylrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone M Blank Thiels ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/21/2006 PRODUCER Circle Business Insurance Agency Inc 247 Newbury St. Danvers, MA 01923 978-777-7030 THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED William Pogor General Contracting Services, LLC 10 Lacy St North Andover, MA 01845 978-685-2425 INSURER A: ESSEX INSURANCE CO INSURER B: Granite State Insurance Co. INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTEDBELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S LT NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MWDDI POLICY EXPIRATION DATE MM/DD/Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY ICLAIMSMADE OCCUR PREMISES (Ea ocwrence) $ 50,000 MED EXP (Any oneperson) $ excluded A 3CS2317 8-19-06 8-19-07 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 11000,000 PRO POLICY FI JECT LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ ALLOWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-0WNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANYAUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ (OCCUR CI CLAIMS MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PAORIPARTNERIEXECUTIVE C 8734899 1-13-06 1-13-07 LIM X TORY ITS I ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 10 000 S OFFICERIMEMBER EXCLUDED? Ifyes, describe under E.L. DISEASE -POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Job: 36 Andover St., No. Andover MA CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER 1600 OSGOOD STREET NORTH ANDOVER MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL lQ__ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 1988 Blank Thiels NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: '96 ��/ 're'c� 51—is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL 11,S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: Fire Department Sign off: Dumpster Permit (Location of Facility) (� SidafWre of Permit Applicant Date Blank Thiels WILLIAM POGOR GENERAL CONTRACTING 10 Lacy Street North Andover, MA 01845 CONTRACT Customer: Glen & Antonia Macon 36 Andover Street North Andover, Massachusetts Project Location: Same as above Nature of Work: ❑ Design/Layout/Concept Services X General Contracting Services MA Home Improvement Contractor License No. 083917 MA Construction Supervisors License No. 139701 Inquiries may be made to: Director of Home Improvement Contractor Registration One Ashburton Place Boston, MA 02108 (617)727-8598 Friday, October 27, 2006 This Contract relates to the above checked services that William Pogor General Contracting, LLC shall provide to Customer. The services being provided are spelled out in the next section. The Customer's Payment Schedule is provided for in the section following that. This is a written binding contract. Do not sign if there are any sections or spaces remaining blank. If the contract is not understood, please have it reviewed by an attorney of your own choice. i 16smkmeruihals ctor Initials Blank Thiels Services to be performed: 1. General Description of Work 1. PERMITS 1.1. Building Permit. 1.2. Electrical Permit. 1.3. Plumbing Permit. 1.4. Gas Permit. 1.5. Waste Removal Permit. 1.6. Occupation Certificate. 1.7. Fire Safety Certificate ( This Price does not include upgrading smoke detectors or Co2 detectors). 1.8. Notifications 1.8.1. As required by North Andover Massachusetts Building Department Form U. 1.8.2. Dig Safe. 2. DEMOLITION 2.1. Demolish Kitchen associated areas according to plans. 2.2. Temporary Supports for any areas deemed necessary by the contractor. 3. WASTE & DEBRI REMOVAL 3.1. Remove all extra debris associated with the Remodeling building process to an appropriate rubbish removal station. 4. FOUNDATION 4.1. Excavation 4.2. Footings, walls (any wall pining), 4.3. Drainage 4.3.1. Install foundation perimeter drain line and terminate to appropriate locations (dry well or city storm drains), if deemed necessary by the contractor. 4.4. Backfill 4.4.1. % crushed stone to fill lower level surrounding drainage area, remainder of the fill area to be filled with bank sand material within 4" of final grade. Remainder to be filled with loam. 5. CARPENTRY 5.1. Framing 5.1.1. Exterior Wall Frame (2X6 KD spruce dimensional lumber). 5.1.2. Tyvek Home wrap or comparable material. 5.1.3. Floor frame (as specified by structural engineering diagrams). 5.1.4. Roof Frame (as specified by structural engineering diagrams). 5.1.5. Plywood Sheathing exterior wall (%Z" CDX Fir). 5.1.6. Plywood Roof Sheathing (5/8" CDX Fir). 5.1.7. Plywood T&G flooring. 5.1.8. Appropriate underlayment or repair of existing kitchen floor area. 2 Cult Initials for Initials TK Blank Thiels 5.2. General Carpentry 5.2.1. Siding (Grade A clear cedar to match existing residence, pre -primed). 5.2.2. Soffits (Soffits vented with 2 1/4" white screen dimensions to match existing residence). 5.2.3. Facia (to match existing residence, pre -primed). 5.2.4. Exterior Trim (to match existing residence, pre -pruned). 5.3. Finish Carpentry 5.3.1. Hardwood Flooring (3 %Z " random lengths grade A clear maple. (All grades select or better)). 5.3.2. Door & Window Casing (popular paint grade). 5.3.3. Baseboard molding (paint grade). 5.3.4. Cabinets acquired an installed Specified Per Initialed plans ( not to exceed $200/Linear foot upper and lower combined). 5.3.5. One Cabinet in Powder room ($600.00 alotment). 6. INSULATION 6.1. Wall, ceiling and foundation insulation as specified energy efficiency certificate found in building permit documentation. 6.2. Proper -vent all roof areas MGL. 7. ELECTRICAL 7.1. Rough Electrical 7.1.1. Rough Wiring 7.1.1.1. Switches (as appropriate for lighting needs). 7.1.1.2.Outlets including GFI as required by MGL. 7.1.1.3.Lights (total four recessed lights). Extras $100 per light plus Trim. 7.1.1.4.lnstallation of stove exhaust fan as required by MGL (owner supplied). 7.1.1.5.Under Cabinet Lighting (below all upper wall cabinets). 7.1.1.6. Two Cable outlets. 7.2. Finish Electrical 7.2.1. Switches (single pole, dual pole, three-way switches as required). Dimmer switches if requested (extra). 7.2.2. Light Trims (white Baffles all recessed). 7.2.3. Outlet and switch covers (synthetic white or Ivory). 8. PLUMBING 8.1. Plumbing Specifications 8.1.1. Plumbing Fixtures are based on builders grade Kohler products. 8.2. Rough Plumbing (one kitchen sink, dishwasher, refrigerator ice line). 8.2.1. Sanitary Lines. 8.2.2. Water Lines. 8.2.3. Gas Furnace Lines if required 8.2.4. All necessary mixing valves. 8.2.5. Install all vents & roof caps if required. 8.3. Finish Plumbing 8.3.1. Install all Finish trims for mixing valves. 3 CPL-- Custoraer Initials or Initials Blank Thiels 9. HVAC (HEATING, VENTILATION) 9.1. Install all gas hookups. 9.2. Install appropriate heating ioop.(baseboard radiant) 10. WALL FINISHES 10.1. Blue Board & Plaster (all walls & ceilings smooth coat). 10.2. Kerdi waterproof barrier for any wall tile affected areas. 11. COUNTER TOPS 11.1. All Counter services are based on antiqued black granite (to match sample). 12. FLOOR FINISHES 12.1. Hardwood flooring (sanded flush, application of black aniline dye finish (two coats high gloss lacquer, one coat semi -gloss, or satin lacquer). Disclaimer - Black Dye alcohol based is by nature is put down as artistic interpretation. Although we will work with the client to a mutual goal. Black dye should be interpreted as a flavor not a goal. 13. SIDING 13.1. Clapboards (grade A cedar, pre -stained to match existing house color). 14. WINDOWS 14.1. Pella windows (to match existing home double hung). 14.2. Exterior Door (full light steel). 15. ROOFING 15.1. Asphalt shingles to match existing home. 16. PAINTING 16.1. Paint specifications (Based on Sherwin-Williams colors and products). 16.2. Exterior (one coat of paint will be applied to all exterior servtes).SLik* C-t� 16.3. Interior (one coat of oil based primer sealer all surfaces, two coats of color customer choice. 17. LANSCAPING 17.1. Rough grade affected soil areas. 17.2. Rebuild exterior granite stairs. 18. FINAL TOUCH UP AND PUNCH LIST 18.1. Upon substantial completion a punch list will be generated signed by both the contractor and homeowner for finish Items. 4 C er Initials ctor in Blank Thiels 11. Dates of Performance (If Itemized Schedule, attach and refer to it here): Commencement Date: Substantial Completion Date: As Soon As Permitted — 6 months from commencement Other Particularly Agreed Dates (if any): No workweeks, Thanksgiving and Christmas. III.Work Changes Any changes to this contract must be mutually agreeable and put in writing under a Change Order Form. A blank Change Order Form is attached after the signature lines below and shall be the form used for any changes to this contract. It shall be the obligation of both parties to adhere to this provision. IV. Contractor's Conditions of Performance All dates of performance are subject to reasonable extension(s), at the Contractor's request, if request is made due to inclement weather, labor disputes, issues involving acquisition of materials or permits from appropriate authorities, mutual dissolution of contract by the parties, stop work order(s) by state or local municipalities, or act(s) of God. Approval of such request(s) shall not be unreasonably withheld. No acceptance of liability is expressed, assumed or implied due to any of these circumstances. Work may be stopped, interrupted or ceased at the sole discretion of Contractor if payment(s) under the terms of this contract, or any written amendment thereto, is not made by Customer as agreed herein. Work shall be performed in an ordinary standard. It is understood that certain portions of Contractor's consulting and drafting work is deemed artistic and/or subjective in nature, and therefore, disputes related to subjective portions of Contractor's work shall never be grounds for non-payment by the Customer. 5 dA_r (I J CMInitials Con or Initials Blank Thiels Permits for Work The types) of permits that will be required for the Contractor's work herein shall include: As stipulated in previous work specifications. Unless otherwise requested by the Customer, the Contractor shall act as the OWNERS AGENT with regard to North Andover Building Department for the sole purpose of obtain all necessary permits required to undertake and complete the project. if the Customer undertakes to obtain :their own permit(s) the Customer will be excluded from the guaranty fund provisions of M.G.L. c. 142A. Special Conditions of Services: (If this section is intended to be left blank, state "none"): None Customer Payment Schedule: This Contract is: X Agreed Fee ❑ Time and Materials Invoiced ❑ Combination Agreed Fee and Time and Materials Invoiced 6 C o er Initials Cofor Initials Blank Thiels ACp greed Fee (If applicable): Deposit (Ten (10%) Percent): This sum is due at the signing of the contract (Subject to Customer Consumer Rescission Rights) First Installment (Twenty-four (24%) Percent): This sum is due upon notification that the building Permit has been obtained. Second Installment (Thirty-three (331Y.) Percent: This sum is due upon Contractor's notification of 50% completion of work Third installment (Twenty-eight (280/o): This sum is due upon Contractor's notification of Substantial Completion of work Final Payment (Five (5110) Percent) Final Balance: This sum is due no later than seven (7) days After final completion of work by Contractor Total Contract Payment: Time and Materials/Labor Invoiced (If Applicable): Initial Deposit: N/A _$7250.00 _$17,400.00 _$23,925.00 _$20,300.00 _$3625.00_ _$72,500.00 Contractor shall be paid at a rate of $_135.00/per two men per hour, plus all materials and out of pocket expenses, including, but not limited to invoiced subcontractors, consultants and materials suppliers. Contractor shall provide an itemized entry of his time billed as part of his invoice together with copies of expense invoices. Invoices shall be issued weekly. Payments due under invoice shall be made within seven (7) days of receipt of invoice. Receipt shall be upon delivery to Customer's address. Contractor may suspend or cease work under this contract if payment is more than seven (7) days overdue. Special materials, or materials of a special order or custom made nature, shall be separately invoiced and require advance payment by Customer prior to order. 7 CusVitials onor Initials Blank Thiels Description of Combination Agreed Fee and Time and Materials: As specified by any extra work orders. Payment terms may not be altered Unless expressly agreed by the parties in writing. Deposit Terms If there is an initial deposit, it shall be non-refundable. The Customer acknowledges and agrees that the Contractor shall commence work in good faith upon receipt of said deposit, utilize his time and that of contractors and/or consultants he may work with, and that the Contractor shall be fairly compensated for such commencement of work and dedication of time to this Customer that might otherwise be devoted to other projects. The parties agree there is valid consideration for the non-refundable deposit. DEFAULT OF CUSTOMER If the Customer defaults for any reason, the Contractor shall be entitled to immediate Payment of all monies owed as of the date the Contractor notifies the Customer in writing that he deems the Customer to be in default. The Contractor's Notification shall state all sums deemed to be owed and due from the Customer. Said sums shall be due and payable within seven (7) days of delivery of said notice. Any sums due after such notice of default shall be assessed an interest charge of i %2 % per month, or 18% per year until all sums are paid in full. If the Customer defaults, and does not tender payment of all sums due within said seven (7) days, the Contractor may record this contract in the registry of deeds and seek a lien on the property for the enforcement of payment. The Customer shall be responsible and owe the Contractor all costs and expenses incurred in the collection of monies owed under this contract, including, but not limited to reasonable attorney fees. 8 Zrs *to—rinitials Blank Thiels ALTERNATIVE DISPUTE RESOLUTION The Customer and the Contractor mutually agree that in the event the Contractor has a dispute with the Customer, the Contractor may submit such dispute to a private arbitration service, of the Contractor's sole choosing; provided however, such private arbitration service shall have been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and which shall have been in business for more than five (5) years, and shall be staffed with at least one retired justice of the Massachusetts Court System. This provision is an election at the sole discretion of the Contractor. This provision is in addition to any rights afforded the Customer under M.G.L. c. 142A. The arbitration, if elected, by the Contractor, shall follow the rules and regulations of the American Arbitration Association. Nothing in this provision shall prohibit the Contractor from initiating a civil action for any such defaults. The Contractor may have the right to institute a civil action to obtain and enforce any statutory liens rights the Contractor may have, while contemporaneously seeking arbitration of the underlying disputed claims, which determination shall be conclusive as to the amount, if any the Contractor may enforce through such civil action lien. CUSTOMER RIGHT OF CANCELLATION YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE CONTRACTOR, WHICH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF, PROVIDED YOU NOTIFY THE CONTRACTOR IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL POSTED, BY TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. 0 Cost Initials Initials Blank Thiels This Contract shall be construed in accordance with the laws of Massachusetts. This Contract may be executed in duplicate. Customer acknowledges receipt of copy by signing below. THIS IS A BINDING LEGAL DOCUMENT. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES OR YOU DO NOT UNDERSTAND ANY TERMS HEREIN. Executed as a sealed instrument this % 4� Customer 10 Casals *Contornitials Blank Thiels NOTICE OF CANCELLATION FORINT Date of Contract You may cancel this contract, without any penalty or obligation, within three (3) business days from the date entered on the first page of this contract. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten (10) business days following receipt by the Contractor of your cancellation notice, and any security interest arising out of the contract 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 contract; 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 the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Contractor, or if 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 contract. To cancel this contract, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to William Pogor General Contracting, at 10 Lacy Street, North Andover, MA, 01845, not later than midnight of: (Date of 3business day.) I hereby cancel this Contract. Customer(s) Signature alt_� Oust Initials (Date) 11 *tor Initials Blank Thiels Permit Number REScheck Compliance Certificate Checked By/Date 1995 MEC REScheckSoftware Version 3.5 Release le Data filename: C:\Documents and Settings\wildwoods\My Documents\William Pogor Building\Clients\resckmacon.rck PROJECT TITLE: Kitchen Addition CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: Single Family DATE: 11/21/06 DATE OF PLANS: 10/20/06 PROJECT DESCRIPTION: Antonia & Glen Macon 36 Andover Street North Andover, Massachusetts 01845 DESIGNER/CONTRACTOR: William Pogor General Contracting Services, LLC 10 Lacy Street North Andover, Massachusetts 01845 COMPLIANCE: Invalid Area(s) Gross Glazing Area or Cavity Cont, or Door Perimeter R -Value R -Value U -Factor UA Ceiling l: Cathedral Ceiling (no attic) 152 30.0 1.4 5 Wall 1: Wood Frame, 16" o.c. 152 19.0 1.4 4 Window 1: Wood Frame:Double Pane with Low -E 17 0.350 6 Window 2: Wood Frame:Double Pane with Low -E 16 0.350 6 Window 3: Wood Frame:Double Pane with Low -E 16 0.350 6 Window 4: Wood Frame:Double Pane with Low -E 16 0.350 6 Window 5: Wood Frame:Double Pane with Low -E 16 0.350 6 Wall 2: Wood Frame, 16" o.c. 64 19.0 1.4 3 Window 6: Wood Frame:Double Pane with Low -E 0 0.350 0 Door 1: Glass 16 0.350 6 Wall 3: Wood Frame, 16" o.c. 152 19.0 1.4 9 Wall 4: Wood Frame, 16" o.c. 152 19.0 1.4 9 Basement Wall 1: Solid Concrete or Masonry 114 0.8 14.4 5 Wall height: 6.0' Depth below grade: 5.4' Insulation depth: 5.4' Door 2: Solid 20 0.350 7 Basement Wall 2: Solid Concrete or Masonry 48 0.8 14.4 2 Wall height: 6.0' Blank Thiels Depth below grade: 5.4' Insulation depth: 5.4' Basement Wall 3: Solid Concrete or Masonry 114 0.8 14.4 Wall height: 6.0' Depth below grade: 5.4' Insulation depth: 5.4' Basement Wall 4: Solid Concrete or Masonry 48 0.8 14.4 Wall height: 6.0' Depth below grade: 5.4' Insulation depth: 5.4' Builder/Designer Date Blank Thiels TOWN OF NORTH ANDOVER MASSACHUSETTS NORTH ANDOVER OLD CENTER HISTORIC DISTRICT COMMISSION Building Inspection Town of North Andover North Andover, MA 01845 TO WHOM IT MIGHT CONCERN: Please be advised that renovations at 36 Andover Street do not need approval of the Historical District Commission. The renovations are in the area which can not be seen from the street and therefore do not need approval from the Old Center Historical District Commission. Any questions please call me at 978 685 5000. Sincerely, ,)& x vllee� George H. Schruender, Jr. Chairman North Andover Historical District Commission Blank Thiels CER77FIED PLOT PLAN PREPARED FOR: GLEN & ANTONIA MACON AT 36 ANDOVER' STREET NORTH ANDOVER. MA. NORTH ESSEX REGISTRY OF DEEDS: BK. 9487 PG. 122 ASSESSOR'S MAP: 59, LOT 24 ZONING: RES 3 SCALE: 1"-50' DATE. NOVEMBER 16, 2006 NOTE: SETBACKS TAKEN TO CORNERBOARD. N OF �o N v � S N0. 3577 t LAt D PREPARED BY' "'""" JOHN ABAGIS & ASSOCIATES, PROFESSIONAL LAND SURVEYORS 9 BAR77.ETT STREET, NO. 252, ANDOVER, MA. (978)-688-4899 JOB NO. 5441 Blank Thiels Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required—I Required—IProvides Required I Provided Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. NOTES and DATA — For department use —77 Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC. Jan2006 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 Location -& (o A igDoye. ST' . { No. Date -1 fi NORT►y ae qL 7 1 1 II TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permi Fee A $ Other Permit Fee$ Sewer Connection Fee $ Water Connection F $ TOTAL $ �- Building Inspector .- 9494 Div. 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APPEALS �DE.i c .�c, NORTH^ ANDOVER Massachusetts o ts.�s CONSERVATION "'' DMSION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KARE` H.P. NELSON. DIRECTOR In accordant! with the prcvisic -s of 1' c S -5-4• a condition of Building Permit Number is that the debris resulting from this work shall be disnosed of in a preperiy :ice: solid •x-aste '�^csai `ac�iitr as ''c :ned by ,ti1GL c III• S 150A- The OA. - ,. . i ne debris will be disposed of in: S 0 1-, F 0, E, I'l I t - Uen S -r K /-7, i.`CCa["On of Facility) Signature of Permit Applicant G C� �s- Date �r ;TOTE: Demolition permit from the Tov-n of North Andover must be obtained for this project through the office of the Building Inspector. 9