HomeMy WebLinkAboutMiscellaneous - 36 KIERAN ROAD 4/30/2018 (2)D�ar�.r � Par6u� Shay
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only
Permit No - la di
h
Occupancy & Fee Checked (�
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts
(Please Print in ink or type all information)
Town of North Andover
Electrical Code 527 CMR 12:00
p'
Date 6/1 / o
To the InsVector 6f Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street $ Number 3 tP IS' I n- V1 P
(21
Owner or Tenant 9 +� lA 1n'1 1— !' In a►
Owner's Address
Is this permit in conjunction with a building permit Yes LV No ❑ (Check Appropriate Box)
Purpose of Building ill S0 -C I kM I I S4 Utility Authorization No.
Existing Service Amps . Voits Overhead ❑ Undgmd ❑ No. of Meters
New Service �2- r^t ri Amps Voits Overhead Lc]' Undgmd ❑ No. of Meters—/—
Number of Feeders and Ampacity �- r
Location and Nature of Proposed Electrical Work
— - —
— - -
— -
Total
No. of Light8ng Outlets
No. of Hot fuse
No. of Transformers KVA
Above ❑
In ❑
No. of Lighting Fixtures
Swimming Pool gmd ❑
gmd ❑
Generators KVA
No. of Emergency Lighting
No. of Receptacles Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
c�
J G
No of Gas Burners
FIRE ALARMS No. of Zone
No. of Detection and
Total
No. of Ranges
a
/'
No of Air Cond
Tons
Initiating Devices
Heat Total Total
No. of Diposal
No. Pumps
Tons
KW
No. of Sounding Devices
No./ of Self Contained
No. of Dishwashers
�r
�`
S ace/Area Hearing
KW
Detection/Sounding Devices
❑ Municipal ❑ Other
No. of Dryers
Heating Devices
KW
Local Connection
Na of
No. of
Low Voltage
No. of Water Heaters
KW
Signs
Bailases
Wiring
No. Hydro Massage Tuds
No. of Motors
Total HP
OTHER:
INSURANCE COVERAGE. Pursuant to the requiremenets of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO =
have submitted valid proof of same to the Office YES = NO ' = If you have checked YES please indicate the type of coverage by checking the appropriate box
INSURANCE = BOND = OTHER = (Please Specify)
Estimated Valuelot� 1e��1 tQ�orkS
c�000 (Expiration Date)
Work to Start lt�o 6 Inspection Date Resqueated Rough Final
Signed under the Penalties of peau ,_ ? %'
FIRM NAME L)a` LIC. NO. `
e.,� I 1 I I Slanature LIC. NO.
Bus. Tel No. `� ZX / r S LZ— �9 `M -
Address 3 1 t'T �cti ;T
//�Q� Alt Tel. No.
OWNER'S INSURANCEWAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
Telephone No. PERMIT FEE
(Signature of Owner or Agent)
N2 'i A66
Date .�L� ... 2i ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .........t .... .
has permission to perform . . ..........................................
wiring in the building of ... ......
. .............
at :7:1;..r�................................... .. . North Andover, Mass.
�91,
Feed ?vr ........ Lic. No. ............................................................
ELEcmicAL INSPECTOR
06/02/98 12:02 On rin
• PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
0
✓IASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS F=G
or print)
i-4VKIH ANDOVER, MASSACHUSETTS
Date6 ` 19
Building Locations %I�e /? A Permit # /3
Owner's Name
New Mr RenovationE]ReplacementLAJ ❑
Amount $
Plans Submitted ❑
or type)=��/ �� �G ��j- Check oeCertificate Installing Company
Name
Address
usiness Telephone
Name of Licensed Plumber or Gas Fitter
❑ Partner.
Firm/Co.
INSURANCE COVERAGE Check � Kr
I have a current liability Insurance policy or it's substantial equivalent. Yes Cl..l No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnityElBond ❑
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 ❑ Agent
t 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 perf un r Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Sta as Code aadChapters 2 ofjthe General Laws.
By:
Title
City/Town
VED (OFFICE USE ONLY)
Signatu3pkfl
❑
PI er
❑
Gas Fitter
❑
Master
journeyman
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SU B-BASEM ENT
BASEM ENT
1ST. FLOG R
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
ST H. F L O O R
6T It FLOOR
7T 11. FLOOR
R T II . F L O O R
or type)=��/ �� �G ��j- Check oeCertificate Installing Company
Name
Address
usiness Telephone
Name of Licensed Plumber or Gas Fitter
❑ Partner.
Firm/Co.
INSURANCE COVERAGE Check � Kr
I have a current liability Insurance policy or it's substantial equivalent. Yes Cl..l No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnityElBond ❑
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 ❑ Agent
t 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 perf un r Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Sta as Code aadChapters 2 ofjthe General Laws.
By:
Title
City/Town
VED (OFFICE USE ONLY)
Plumber Or -Gas Fitter
License Number er
Signatu3pkfl
❑
PI er
❑
Gas Fitter
❑
Master
journeyman
Plumber Or -Gas Fitter
License Number er
2873 a
Date......... .......
J'
I
,ORT#q TOWN OF NORTH ANDOVER
Oy,�.ao ,e1tiOL
A PERMIT FOR GAS INSTALLATION
Z 1'74
This certifies that ... .:? :$:^--/...:...::✓f .. ............. .
has permission for gas
o '
in the buildings of !-�r-:..'��.•.•:*:-Y:-f•: ...................
at .:"'(. !!+.1 w.=.�-,�,!'. ......... , North Andover, Mass.
Fee..C' .�. Lic. Nol�q'e.,?�? . ..........................
GAS INSPECTOR
WHHVWp'0IJatrC'3 CANA*Y06uild%V%ept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICA ION FOR PERMIT TO DO PLUMBING
'ype or print)
NORTH ANDOVER, MASSACHUSETTS y Date z_
Duilding Locations `�� �1 /���� � � Permit # �
Amount /2 ev
Owner's Name
New � Renovation0 El
Replacement Plans Submitted
FIXTURES
(Print or type) Check one: Certificate
Installing Company Name 1,L'T ��� 0 Corp.
Address F1 Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber: /o
Insurance Coverage: Indicate the type of a coverage by checking the appropriate box:
Liability insurance policy El Other type of indemnity 1 Bond ❑
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 11 Agent n
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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts S umb Co
aV Chapter 142 of the General Laws.
By: igna ure ot L1CWa,FjVM5er
Type of Plumbi
Title
City/TownI� �um er Master ❑ JourneymanT
APPROVED (OFFICE USE ONLY �L.�1
M
(Print or type) Check one: Certificate
Installing Company Name 1,L'T ��� 0 Corp.
Address F1 Partner.
Business Telephone Firm/Co.
Name of Licensed Plumber: /o
Insurance Coverage: Indicate the type of a coverage by checking the appropriate box:
Liability insurance policy El Other type of indemnity 1 Bond ❑
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner 11 Agent n
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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts S umb Co
aV Chapter 142 of the General Laws.
By: igna ure ot L1CWa,FjVM5er
Type of Plumbi
Title
City/TownI� �um er Master ❑ JourneymanT
APPROVED (OFFICE USE ONLY �L.�1
w
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Cype or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations
Date
Permit #
Amount
Owner's Name
New 0 Renovation 0 Replacement 0 Plans Submitted n
FIXTURES
y i^
(Print or type) Check one: Certificate
Installing Company Name n Corp.
Address n Partner.
Business Telephone Finn/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy El Other type of indemnity a 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 11 Agent M
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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By: signature ot Licenseaum er
Type of Plumbing License
Title
City/Town License Number Master ❑ Journeyman ❑
APPROVED (OFFICE USE ONLY
I
-
.-----�------------------
16�v 00 Bel
(Print or type) Check one: Certificate
Installing Company Name n Corp.
Address n Partner.
Business Telephone Finn/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy El Other type of indemnity a 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 11 Agent M
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 Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By: signature ot Licenseaum er
Type of Plumbing License
Title
City/Town License Number Master ❑ Journeyman ❑
APPROVED (OFFICE USE ONLY
���'�-'4r=— ...ao--:1.-...'..J+ ..�.? W"V,rv'.^�'� •��cY',.y.liY_,�-��`...��.� r �.,.��N._. �rlr'�'�. ..1
.. Date....:
3716
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SgACMUSE�
This certifies that . i?.... `f . ............. .
has permission to perform✓, ,.......... .....
plumbing in the buildings ""'?.... ............
at . ".� .. !'..:........... .North Andover, Mass.
Fee ��'°:..... Lic. No/g.3%. ...............................
PLUMBING INSPECTOR
06/02/98 12:03
WHITE: Applicant
120.40 PAID
CANARY: Building Dept. PINK: Treasurer
PERJtiT NOS &APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
I
PAGE 1
MAP 4-40.
LOT NO.
I--
I
2 RECORD OF OWNERSHIP DATEBOOK
I
'PAGE
I
`f
SUB DIV. LOT NO.
_JZONA/i
I
3 (
/
LOCATION
PURPOSE OF BUILDING eCrC,4, a4 C Ir
!�
OWNER'S NAME I Iwn//J.� �i
l/ J
NO. OF STORIES SIZE
OWNER'S ADDRESS
�}CD
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST�.iO� I �2t�n.
SPAN
3RD
BUILDER'S NAME
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
'" "' POSTS
DISTANCE FROM STREET
DISTANCE FROM LOT LINES — SIDES
� REAR I,
GIRDERS
AREA OF LOT7 /„'
w
FRONTAGE /Vy. Y
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING
Tu� 1-SjC
IS BUILDING ADDITION �/1Q
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 QS
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 - 3
f
PAGE 2 FILL OUT SECTIONS 1 - 12
R 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
FEE
PERMIT GRANTED
-{
19
OWNER TEL 9_-g�6e3
CONTR. TEL. # V S7$-
CONTR. LIC. #_
3 PROPERTY INFORMATION
LAND COST
-EST. BLDG. COST
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
BUILDING INSPECTOR
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
STORIES
MULTI. FAMILY
OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
—I
J
8 INTERIOR
FINISH
CONCRETE
PINE
B
1
2 13
_
CONCRETE BL K.
BRICK OR STONE.
HARDW D
PIERS
PLASTER
DRY WALL
UNFIN.
3 BASEMENT
AREA FULL
FIN. B M T AREA
'i. 1/7 '/,
FIN. ATTIC AREA
_
NO B MT
FIRE PLACES
_
HEAD ROOM
MODERN KITCHEN
_
4 WALLS II 9 FLOORS
CLAPBOARDS
B
_
1
2 3
�_
_
_
_
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
CONCRETE
EARTH
HARDIVJ D
COMMON
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
_
BRICK ON MASONRY
ATTIC STRS. 8 FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
GAMBRELMANSARD
I
11
HIP
BATH (3BATH (3 FIXE
TOILET RM. 12 FIX.)
_
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR 8 GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
_
TILE DADO
Fi FRAMING f l
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. 8 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_
I:r 13rd
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.
.17T•aii
1-9cation.,����1
No. _. Date
NORTp TOWN OF NORTH ANDOVER
p Certificate of Occupancy $"`'
Building/Frame Permit Fee $
�►�s'Arm "'�<�' Foundation Permit $ —
s�cMusE ,a��z.0 I
OtheA' .& It Fee $ U
Sewer Connection Fee $
Water Connection Fee $
TOTAL
A� Building Inspector—'
03/22/9410,,07 97.50 PAID
7079
""" Div. Public Works
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CER TIF/ED PLOT PLAN
PREPA RED FOR.
WILLIAM FLANAGAN
AT
36 KIERAN ROAD
NORTH ANDOVER, MA.
N0. ESSEX REGISTRY OF DEEDS.' BK. 1,390 PG. 316
'PLAN.' No. 4,705
ZONING.' R-3 ASSESSORS.' MAP 98A, PARCEL 48
SCALE.' / 50' DATE.' DECEMBER /4, /993
- 204.53' ,
Lor 17
5s ai' 26, 267 S.F. t
34.3
0
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\2
FRAM
'-'44.97�� �
KIERAN
7,im
':• A&W
✓OHN M. ABAGIS
6/.33
64.75'
/45.70 -
ROAD
NOTES:
/)DIMENSIONS BASED ON FIELD
SURVEY PERFORMED ON /2-14-93.
2) LOCUS /S /N THE WATER SHED
DISTRICT.
PREPARED BY.'
JOHN ABA GIS 8 ASSOCIATES, PROFESSIONAL LAND SURVEYORS
137 CHANDLER ROAD, ANDOVER, MA. (508)-688-4899
N0. /, 762
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rUKM U - LOT RELEASE FORM
INSTRUCTIONS: This forr% is used to verify that all necessary a J
Boards and+.^_ -apartments having jurisdiction have been obtained. This does not is from
the applicant and/or landowner from compliance with any applicable or r ,cellere
equlrements.
'"*"APPLICANT FILLS OUT THIS SECTION TM
APPLICANT \ 1 1 �
D�(qH PHONE 7 •Ct Z-�!�
LOCATION: Assessor's Maapo�p Num�r cMs l "�
PARCEL
SUBDIVISION q? A-
LOT (S) _gyp
STREET 3(
ST. NUMBER
OFFICIAL USE ONLY
NDATIONS OF TOWN AGENTS:
ADMINISTRATOR
DATE APPROVED
DATE REJECTED
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
TH
DATE APPROVED g
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
-------------
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
DATE
&®vs i I I I&�A 11% /1VVVV1/1 1 L VI IAI\/.
.630 TURNPIKE STREET N. ANDOVER MA TEL. (508) 975-7117
MW7MLA OM MILLZW M.& EZIZAW7N 8. PL.AM46WN RM 13W / 91.6
LOCATIOft 39 KXfiMW ROAD PLAN ffiF. PLO 470
CITY, BTA M A4WM AACOYM 94 OCAL& 1s, 40 •
44 TM 10 / PS / 93 alb * W 08147
NOTE: This mortgage inspection was preparedOj
specifically for mortgage purposes only and
is not to be relied upon as a land or property
-line survey. Wilding locationand_offsots
shown are specifically for zoning determination
only and not to be used to establish property
uS
lines. The land shown hereon is based on
13972
referenced information noted and nay be subject
to further takings and easements. Northern
ECI$TEaE�
Associates, Inc. accepts no responsibility for
����E
damages resulting from said reliance by anyone
iaNO�
other than the said mortgagee and its assigns in
connection with its proposed mortgage financing
to said mortgagor.
This mortgage inspection was prepared in accordance
with the Technical Standards for Mortgage Loan
Inspections as adopted by the Massachusetts Board of
Registration of Professional Engineers and Land
Surveyors 250 CMA 605.
I further state that in my professional opinion that
the structures sho%ln conform with
the local zoning horizontal dimensional setback
.,� requirements at the time of construction or are
exempt under provisions of M.G.L. CH. 40-A Sec. 7.
f
Property/House in -not in a Flood Hazard.
2.Property/House is in a Flood Hazard Area.
3.Information is insufficient to determine
Flood Hazard.
Flood Hazard determined f1e pp Federal Flood
Insurance Rate Map Panel m 7 6
Date
1
The Commonwealth of Massachusetts
Department of Industrial Accidents
OUice0111INsUgaUens
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
name:
location:
city
phone a
0 I am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or
one years' imprisonment as well as ivil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a
COPY of this statement maybe forw ded to the Office of Investigations of the DIA for coverage verification.
do hereby c ify under the p and penalties of perjury that the information provided above is true and correct
Signature ' 1 tom' `Q Date i •ci8
Print name �.J t \ IQtM G - 6!(A%Ay�#e� Phone # Z Vol • Cf -32- -.1 1 go
I r.
official use only do not write in this area to be completed by city or town official
city or town: permit/license a r'1Building Department
Q check if immediate response is required QLicensing Board
QSelectmen's Once
Qliealth Department
contact person: phone q; _ —Other
(revised 7/95 PU)
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Bostofy MA 02111
www.massgovldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
AyRlicant Information Please Print L.er ibly
Name (BusinesstorpmzanonwividuaD:�M
Address:
City/State/Zip: �,`� b�..>� .� ��.. o v Phone #:
Are you an employer? Chetk the- appropriate box:
t . VI am a employer with 2
4. [:11 am a general contractor and I
employees (full and/or part-time).'`
have hired the sub -contractors
?. ❑ I am a ale proprietor or partner-
listed on the attached sheet I
ship and have >m etnpioyees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
5. ❑ We are a corporation and its
(No workers' comp. insurance
required.]
officers have exercised their
3. ❑ I amt a homeowner doing all work
right of exemption per MGL
myself. [No workers' comb.
C. 152, § l (4), and we have no
insurance required.]PbY
(NO workers'
crinip. insurance required.]
Type of project (required):
6_ ❑ New construction
7.Remodeling
8. ❑ Demolition
9. [] Building addition
10rectrical repairs or additions
11.❑ P1wribing repairs or additions
12.❑ Roof repairs
13.❑ Other
Any apptictmt that checks box g I niwo also fill out the section below showing their workers' conVerrsmtion policy information:
Homeowners wbo submit this affidavit indicating they we doing all work and then hire outside contractors must submit a new affidavit indicating such
lontractors that check this box (must attached an additional sheet showing the (mane of the suircontractors and their workers' comp, policy information.
am an employer that is providing workers' compensation, insurance for my employees. Below is the. policy end job site
nfonnathm /^
nsurance Company Name: v `,., ,A �� 5� ✓
Policy # or Self -ins. Lic. #: _ b&,t-e L'3 Expiration Date:
ob Site Address: � w ----i
Mach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
,ailure to seance coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine up to $1,500.00 and/or one-year imprisourrtem, as well as civil penalties in the form of a STOP WORK ORDER and a fine
if up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
avestigations of the DIA for insurance coverage verification.
do here eertifp under the pains and pe of pe 'ury that the information provided above is true and correct.
O)Twid use only. Do not write in this area, to be completed by city or town of eiaul
City or Town: Permk/Ucense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: Phone #:
Se
Co
Building Contractor
Proposal
To: Bill & Beth Flanagan
36 Kieran Road
North Andover, Ma. 01845
From: Kevin Murphy
CC:
Data, 5/29/2009
Job: Front Portico / Replace front door
Date of plans: None to date
Architect: Owner / Contractor
Location: Same
Section I - Work Schedule
• 169 Boxford Street
North Andover, MA 01845
• _ PH: 978-688-6335
• FAX: 978-688-7207
All Home improvement Contractors and Subcontractors
engaged in horse improvemerd contracting, unless
specifically exempt from registration by Provisions of Chapter
142A of the general laws, must be registered with the
Coar ramearth 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.(617)-727 6598
Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in
writing contractor will begin work on or about 5/25/09.
Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 6/30/09. The owner hereby acknowledges
and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as
violations of this agreement
Section 11- Warranty
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year
following completion and shall comply with the requirements of this Agreement In the event any defect in workmanship or materials, or
damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job,
including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair correct, replace, or cause to be remedied, repaired, or
replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in
connection with the agreed-upon work.
Section 111- Scope of Work
I%evfi n IS mVpIiny
Building Contractor
169 Boxford Street
North Andover, MA 01845
PK 978-688-5335
FAX 978-8-)000(
General
Building permit will be provided by contractor. Final design / price to be confirmed prior to start
Foundation
New portico will be built on top of existing front stairs.
Building
Page 2 of 4
All frame, roof, and siding materials required to build portico and replace existing front door, will be provided by
contractor. Any rot will be replaced. An allowance of $500 has been included for door unit. Square columns will
be built out of pressure treated lumber, and wrapped with Azek. Composite railings will be installed. Ceiling will
be beaded v joint pine.
Electrical
Electrical work required to add one light in ceiling of portico, will be provided. Surface mounted fixture to be
provided by owner.
Painting
No allowance has been made for any painting.
Waste Removal
All construction debris will be disposed of by contractor.
]Zevfim fes, Wn?EUy
BuBdii g Contractor
169 Boxford Street
North Mdover, MA 01645
PH: 97866&5335
FAX 978666-)000(
Section IV - Price Schedule
Total
Page 4 of 4
We hereby propose to furnish material and labor— complete
in Accordance with above specifications for the sum of ..................................... $ 6500
Payment to be made as follows:
PercentagelItem
Description
Amount
1
Permit obtained
$2000
2
Job complete
$4500
2
1$6,500.00
`"Notice: No agreement for Hare uVrovement contracting work shall require a down payment (a&vanoe deposit) of more that one-third of the total contract price of the total ar mint of all deposits or
payments which the contractor nx>st make, in advance, to order and/or otherwise obtain delivery of special order materials and equiprnent, whidrever is greater
Contractor. Kevin Murphy
169 Boxford Street
No. Andover, MA 01845
Registration No: 101874
Section V — Acceptance
Acceptanceof Proposal — I have read this document and accept the prices, specifications, and conditions stated. I
understand that upon signing, this proposal becomes a binding contract You are authorized to do the work as specified.
Payment will be made as outlined above.
You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this
transaction cancellation must be done in writing
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Signature Date L-
Signature,
Date
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