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HomeMy WebLinkAboutMiscellaneous - 4 CHRISTIAN WAY 4/30/2018I 14 M Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 544 - This certifies that ....... K:'5� .................................................... has permission to perform ......... 6�!!�ep'Z'7 . . ..................................... wiring in the building of .................. P./i I .................................. at . L5 7—,(,,.V/L./ (M�'? .............. North Andover, Mass. ........................ .. 00 777� ........................... Fee..��e ... Lic. No. �1.�X .......... Check # V S-3-9 4LEMICA-L. INSPECMR 7- E . .1 - k- LJ v Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only. ' Permit No.7� . Occupancy and Fee Checked Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFEOcRcMal �ELECTRICALode (MEC), 527 CMkooWORK All work to be performed in accordance (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: % -"a tel - City or Town of: /t%D�7f� /�1��1f1��lZ To the Inspector of Wires: By this appliciation the undersigned eives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ^� Telephone No. ?& Owner or Tenant Owner's Address S4 F'�dLtit tp'. (Check Appropriate Box) � Is this permit in conjunction with a building permit? Yes No ❑ 3 Purpose of Building .S t'GL� Li�/{'�!L- ��USE Utility Authorization No. It Overhead V Undgrd ❑ No. of Meters 01Y_1!5 Existirg. Service 20G Amps o s New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: IN j�Iht��. Q Completion ofthe following table may be waived by the /nEector of Wire No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans 1V0_._0T rotas Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA ove n- Swimming Pool rnd. 0 rnd. o. o mergency ig mg Batter Units No. of Luminaires No: of Receptacle Outlets /� No. of Oit. Burners FIRE ALARMS 'No. of Zones No. of Detection an No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat u P Totals: Number ........ ons ........................ o. oSelf-Contained Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW un►cipa Local ❑ Connection ❑ Other Heating Appliances K�'�' Security stems: No. Devices or Equivalent No. of Dryers of No. o Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent e ecommunications iring: No. Hydromassage Bathtubs No. of Motcrs Total HP No. of Devices or Equivalent OTHER: Attach aaaitionai aeiuu y uesireu, ui UJ icy"..— "r ....... , •• •• __. 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 a BOND ❑ OTHER ❑ (Specify:) I Certify, under thepains andpenalties ofperjury, that the Information on this application is true and complete. FIRM NAME:LIC. NO.:A1 1983 Licensee: _ LOIS f`nNTTNn •Signature LIC. NO.:F�E�Sg (/f applicable, enter "exempt" in the license number line) ' Bus. Tel. No.:.9 7 8-3 61— SA -2 0 Address: nn Tnytnis nu TEST NEWSURY� Nl11 01 9B5 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic, No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law, By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent . PERMIT FEE: $ Signature Telephone No. fl�evj dK -e toyli , 44 Date. .0. -7. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . ;� , - - -- ................ .......................... has permission to perform ? ............... e,, I ....... plumbing in the buildings of .................... at ...... .......... North Andover, Mass. Fee. ....... Lic. .............. PLAZANG INSPECTOR Check # -">J%, G I � 6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) ��1� NORTH ANDOVER, MASSACHUSETTS Building Owners Name Date Permit #/�3 3 Amount -j Type of Occupancy New0 Renovation � Replacement Plans Submitted Yes ❑ No ❑ FIXTURES (Print or type) Installing Company NameA ��//1 !'j Check one: Certificate Corp. Partner. rl Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E Other type of indemnity ❑ Bond J Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsuranc ignature OwnerEr 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 Iss ed for this application will be in compliance with all pertinent provisions of the Massachusetts SPlumbi Code and Cha er 142 of the General Laws. By: igna ure 01 enseci Tumoef Ty e of lumbi g License Title -5-- City/Town icense um er MasterElJourneyman �►-- APPROVED (OFFICE USE ONLY : k ! ti J cz The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Ifashingtan Street Boston, Af 4 02111 www massgov1dia . iWorkers' Compensation Insitr'a.nce Affidavit: Builders/Contractors/Electricians/pi tubers 0cant Information Name(Busincss/prPnization/Individual): Address: city/State/zip: C� Phone �� Are you an employer? Check the appropriate box: I • ❑ I am a employer with 4. ❑ I am a general contractor and I _ y iployem (full and/or part-time).* 2. f �'I am.a.sole proprietor or have Wred the sub -contractors listed partner- ship and have no employees on the attached sheet. # These suf}-cont metors have working for me in any capacity. [No workam' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No -workers' comp, c. I52, § I (4), and we have no insurance required.] t employees. [No workers' • comp, insurance required.] Type of Prot (required): 6. ❑ N construction 7. ffRemodeling 8. Q Demolition 9. ❑ Building addition I0.❑ Electrical repairs or additions 1 I .Q PIumbing repairs or additions I2.Q Roof repairs I3.❑.Other "Any applicant that Checks btu # I must ¢Iso fill out the section below showing their workerd' oom i I t Homeowners who submtt this atirdavit inditatin they are lain all work B pensation policy mformahon. $Contractors that check this boz must alta B B and then hue outside contlactots must submit a new affidavit indicating such loud an add;tional sheet show' the Ramo of the sub•cottuac tots and their workets' tort e' r po.t— jr forrnadon. arta an employer that isprot i&ng,:workers' r aontpens�rt nsuranre or information, f R' employee Below is die policy and job site . Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address. Ijz City/State/Zip: Attach a copy of the workers' compensation policy decfarati Failure to s ' page (showing the policy number and expiration daubed ecure 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 fans of a STOP of up to $250.00 a day against the violator. Be advised that a copy of this statement may be fWORK ORDER and a fine orwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penaltEes pfPerjury that the information provided above is par md rooted ficial use only. Do not write in this area, m be compieted by chj, or town officio[ City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. Crty/Tovvn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: w,�7 SAX c�;CCA Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofbire, express or implied, oral or written." An employer is defined as "an individual, partnership, assodiation, corporation or other legal entity, or any two ormore of the'f6mgoing engaged in a joint enterprise, and includirig the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, associatiori or other legal entity, employing employees. 'However the owner. of a dwelling house having not more than three apas-finents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work an such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.or compliance with the insurance 'coverage required" Additionally, WGL chapter I52, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence ofcompliance with the insurance requirements of this chapter have been presented to the cor &acting authority." Applicants Please fill out the workers' compensation• affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es), and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pm* nit or license is being requested, not`the Department of Industrial Accidents. Should you have any questions regar-ding the law or if you are required to obtain a workers' compensation policy, please -call the Department at the numberlisted below. Self n+.s1tTtd comppries gkraiu d entrrtnp;r self-insurance license number on the'appropriate line. City or Town Officinis Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/liconse number which %viII be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating -current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of -the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license; or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to compiete this affidavit. The Office of Investigations would Ike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 42111 TeL 9 617-727-4900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax 4 617-727-774 www-mass.gov/dia tocation -�No. Dat-/ 'A" Check # / �/ )6 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ MI Y Foundation Permit Fee Other Permit Fee TOTAL ij $ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT I APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING —777 :. , ` � �z & r • �_' �-� �� �pt� (�i�i>1111,�C�i}i� � � ' _ � �. BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE of Buildings Date SECTION 1- SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 4 GIS(,\Sf4�n U -9a 0# ,D/ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.LC.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHW/AUTIIORIZED AGENT 2.1 Owner of Record Oa\E. L',,c,-x Mec-5 fit; y 0h�i�'k.a� n �U�►V Name (Print) Address for Service Signature Telephone 2.2 Owner pf Record: Name PNt Address for Service: a Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: �3 ()h, v\ 6 . kk 0\ M 0 - License( on Supervisor: M�t�nUe� , N1A Address g7�-6�a-7�ioo t naturcj V Telephone 3.2 Registered Home Improvement Contractor PgNi� Enc.`os�)ces Ing, Company NamifID&(\ t5 0c. -+) �et�,�Qn MIS Address I /[�� Ot �b�, 7qc) Not Applicable ❑ C5 07Blg3 License Number 1-.#,I tS/aOO4 Expiration Date Not Applicable ❑ k%75b5 Registration Number �q aoo� Expiration ke 0 r - SECTION 4 - WORKERS COMPENSATION (M.C.-T. C 152 S 25rtm Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check ail applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify_ —5Ecv n 5L),% root c,n Brief Description of Proposed Work: v��� `�:x 1a 3-5L�>Ck5or\ 500('06 ©l) e-��Sl��`✓� C e. T2ar 0 of n (s f\ en SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICJAL USE �?N.Y 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (d) X (b) / 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 -1 Check Number SECTION 7a OWNER AUTHORIZAT ON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Si natur of Owner Date SECTI 7� ^NER/AUTHORIZED AGENT DECLARATION Herebv and bel Print Name as Owner/Authorized Agent of subject that the statements and information on the foregoing application are true_and accurate, to the best of my knowledge �WMUTAYJ 41 Jul -16-01 01:06P �(�fU P-05 FORM! U - LOT RELEASE FORM L' INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ............ ......",.,t.wAPPLICANT FILLS OUT THIS SECTION"'*'`*""*"'••'••_ APPLICANT OInn 6. i-���Me t ?4lb E41b50(e'> 191 -)PHONE Q70 -693 -TIDO -- LOCATION: Assessor's Map Number SUBDIVISION STREET QLNC-$}r&6(\ \Qo-V PARCEL LOT (S) ST. NUMBER_ ►t..'.............................,.......OFFICIAL USE ONLY ** RECOMMENDATIONS 1`', C NSERVATION COMMENTS W&I TOWN PLANNER COMMENTS TOWN AGENTS: TRATOR DATE APPROVED S DATE REJECTED DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED - - ,7 DATE REJECTED IC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm y MORTGAGE INSPECTION PLAN INC.NORTHERN ASSOCIATES, �• .94,� N. MAIN STREET ANDOVER MA 01810 TEL: (508) 474-4410 FAX,- (509) 474-5067 MD4r SUM DALE 6 LISA AVgWr LOCA rraV 4 ChRXSrIAN MA Y CrK STATE` NoRm AmovER MA DATE.` s / 11 / 86 1. 20.00' 6.150.00' 2. 22.25' 7.458.67' 3. 175.04' 4. 106.00' 5. 244.22' H K DEED AEF. 86 / 309 PUN AEF. PLO 96909 P BCALE' 1- 40' " /: &ff/ 00788 150.00' l , 1 1 38'+/- 1 1 1 screenporc deck 36'+/- # 4 2 STORY WOOD ti .p N N L O T 59 easement' _ .o Ln o rn ... ••'. ►:•- J�W (%J4•r�LrIL(IrEIIX''ILCLiI iy B04 ON SUPERVISF BUILDING OR s I License. C Number: CS 078193 s Birthdate: 12/15/1964 Expires: 12/15/2004 Tr. no: 78193 Restricted To: 00 JOHN G HULME�:�� 23 NORWICH LANE Administrator METHUEN, MA 01844 A CQIQD CERTIFICATE OF LIABILITY INSURANCE OP ID ATI012 DATE (MM/DD/YY) 07/03/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The James B. Oswald Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1360 East Ninth Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE Cleveland OH 44114-1715 Phone: 216-622-7400 Fax:216-241-4520 INSURED INSURER A: American Motorists Ins. CO. INSURER B: Lumbermens Mutual Casualty Co. Patio Enclosures, Inc. ALL LOCATIONS Corporate address: 700-720 East Highland Rd. Macedonia OH 44056-2112 INSURER C: INSURER D: INSURER E: 07/05/02 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE (MM/DDNY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one fire) $50,000 A X COMMERCIAL GENERAL LIABILITY 3MG81323300 07/05/02 07/05/03 CLAIMS MADE F7;j OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 7X POLICY JECOT LOC Emp Ben. 11000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 A X ANY AUTO 3MJ81322300 07/05/02 07/05/03 (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000 B X OCCUR F1 CLAIMS MADE 3ZA00037000 07/05/02 07/05/03 AGGREGATE $5,000,000 $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND X TORY LIMITS I I ER A EMPLOYERS' LIABILITY 3BG10633000 07/05/02 07/05/03 E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $ 500000 E.L. DISEASE -POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCA IONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Workers Compensation is applicable in all states except Ohio. CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION BLANKCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_ 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. AUT IED REPRESENT VE ACORD 25-S (7/97) ©ACORD CORPORATION 1988 � -• , ,�_ '�f6's J fi3n;� .zu.Palf! o�QG a; RegaMHaos nail StlndartV . HOhk IMPROVkMENT CONTRACTOR,. 10/t*2002 1 , type: Surplemant Card PAM O�URES INC "S6N ' HULME 2 wi'vvte Xverue }5ahy, NY 12705 � Adrolilxtrwr Jul -16-01 01:06P . Town of North handover Building Department 27 Charles Street Noah Andover, Massachusetts 01x45 (978) 6.89-9545 Fax (978) 638-9542 DEBRIS DISPOSAL FORM P_06 E N0RT►y t O - 04 { "4 wo �S-4 HUS � In accordance with the provisions of MGL c 40s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c I. s150a. The debris will be disposed of in /at. - Facility �q -t-)%c,— Signator` of Applicant Date — --- NOTE: A demolition permit From the Town of North Andover must be obtained for this project through the Office of the Building Inspector, 780 CMR: STATE -BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDINGCODE CONSUh1ER INFORMATION FORM - "SUNROOMS" Massachusetts State Building Code (780 CMR, Appendix J, Section J1.1-2.3.1) The Massachusetts State Building Code (780 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the buildings permit application when a builder/contractoror homeowner, constructingfinstalling a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR; Appendix J, Section J1.123:1). This FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year-round comfort considerations involved in selecting and utilizing a "sunrooe addition. The connection of "sunroom" structures to residential buildings May create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of'the train house. In the selection and construction/installation of "sunrooms", included below is a non -required, open-ended list of product and design considerations that a homeowner may wish to consider before actually constructinglinstalling a "sunroom". It is recommended that consumers carefully review -these options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSiDRRSTTrI_NS RFT_eTFn TO "SUNROOWI • Solar Orientation and Natural Shading r • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials/ seal durability and/or weather tightness of the sunroom • Adequate ventilation - Operable windows and fans • Applied Shading Systems • Insulation level In floors, walls, and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency, Zoning and"Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section JI.1.2J.I. requires that the actual property owner (not the owner's agent or representative) acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance . this requirement, the undersigned hereby acknowledges that she/he has read the information in this d eat cQniccrmruinLsunroorilcomfiort and energy conservation. Signature of Actual Building Owner Date Dale Mea,5k, 'S Print Name Address of Permitted Project Owner Address (if different than project location) 92f (A2.?- G1t3 -Z�_ Owner's telephone number 682 780 CIMR - Sixth Edition 11/27/98 r- {vµ tt" • AVli2Lit till3 9iTI0 3 LIT 23TLjSTOUrT;�fl I SaT IEIr1wu E St S4iWPUP" uv UU14,V0k-aLU --- (JLJJI41, 1; ; fy- METHUEN - (978) 682-7400 TAUNTON (508) 822 1966 WORCESTER (508)'756-ilai ENCLOSURES,.�NC. FAX... (508) 821-9339 r ® TOLL. FREE (888) 333-1966 FAX: , (978) 682-0061 AN EMPLOYEE OWNED COMPANY 1* 500 MYLES STANDISH BLVD. 41 15 AEGEAN DRIVE UNIT!5 METHUEN, MASSACHUSETTS 01844 TAUNTON, MASSACHUSETTS 02780 HOME IMPROVEMENT CONTRACT MASSACHUSETTS REGISTRATION #117565 20 G7�„ Date: Page #2: Seller agrees to furnish labor and materials at Buyer's request, and for the contract amount, to complete the work desch above, subject to the terms and conditions which appear on both Page 1 &Page 2 and on the REVERSE sides of this contract. Work to start approximately A'- weeks from the date of this contract, and to be completed approximately -2L after commencement if not delayed by building permit, delivery of materials, weather, strikes, fires, or other conditions - beyond Seller's control. The completion date is not of the essence. Buyer represe and an legal ifle to -the property, which is to be improved, is in the following owner(s): r" 2. 1. ' NOTICES 1. Seller and/or all subcontractors, if any, who perform on this contract, and who are not paid, may have a claim against you which may be enforced against the property being improved in accordance with the applicable lien laws. The contractor and the homeowner hereby mutually agree, in advance, that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Busin/ds Regulations and the consumer shall be requir d to submit to srbitration as provided in MGLC. 142A. Contract r 'J Owner ? NOTICE: The signatures of the parties above apply ONLY to the agreement of the parties to alternative dispute i initiate alternative dispute resolution even where this section is settlement initiated by the contractor. The owner may not separately signed by the parties. WHERE REQUIRED HOMEOWNER TO GET PERMIT Source of zjaie: Contract Price $�t- (�,*THE DOWN PAYMENT SHALL BE A Down Payment $ `�7' �,"_ ` NONREFUNDABLE DEPOSIT ONCE THE THREE \ AY CANCELLATION PERIOD HAS EXPIRED. THIS CONTRACT CONSTITUTES THE ENTIRE 4 $ Balance Due �< < 5 DERSTANDING OF THE PARTIES. Upon Installation $ 31 You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller 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 the attached Notice of Cancellation for an explanation of this right. Customer acknowledges receipt of a copy of this contract, product warran and duplicate notices of cancellation. DO NOT SIGN THIS CONTRACT IF THERE AR ANY B NK ES -1 Date Down Pa1¢rten eceived: _ - (CustomerSignature) By: gnature of PEI Repre tative) (Customer Signature) and REVERSE sides of this contract. Subject to , erms and conditions which appear on both Page 1 & Page 2 _ TAUNTON \ (508),822-1966 FAX (508) 82t-339 WORCESTER (508) 756-2141"ENCLO�00tMETHUEN (978) 682-7400 SURES, SNC. ® TOLL FREE (888) 333-1966 FAX (978) 682-0061 AN EMPLOYEE OWNED COMPANY 15 AEGEAN DRIVE -UNIT 5 500 MYLES STANDISH BLVD. METHUEN, MASSACHUSETTS 01844 TAUNTON, MASSACHUSETTS 02780 HOME IMPROVEMENT CONTRACT MASSACHUSETTS REGISTRATION #117565 DATE: r_41 --i 20_3 Page 1:k; I, we hereby accept your proposal. to furnish all labor and material necessary to perform the following work on the premises of the Owner 1 !ti' located at in the City of �k-.ci ! NLI Sta a of J"Iy Zip �- l �" Tele: 9'7 This contract shall be considered non -cancelable after legal cancellation period has expired. -# THE tWORK TO CONSIST OF: LA G L t ` i 1 �'_.-1 ti � (..•�..i'i ! C .}. h1 rte_ c::, <, .J 1c .. �- I 3, r- 1 ""!yl/fit i.�l• I /l -t is +�, k.'i.i✓C.. ~ .�c� ni 5 �.yll " St.��- `5� r-)'J""'t� t E•t:` !c:_: 1 c.:J �4: _ ,' tic (e �>u � (��)lG.�� C--. X1 i !'.-- i't.iLc'��. i.�.��_ c..:.il e�.� f�r.:..•E: ��lr•t., r„�.,. }) - Jt Ll J{� a,.. i)G.` l.,_'.� 1. �-•�"tit ',1r�t1 (.— J�1 l�I,. -t •t� ,rc!`l�-.0/)i. 11!<. t.At l i., 12.E �=.i` f.,t,2 ( lit��i W)1 n •� 1 ,(�I a rT Single Glazed AllView, Single Glazed Vinyl, AllView with insulated glass and non -thermally 1 ARE NOT desi ned to be heated or air conditioned. ComfortView Sunrooms with insulated g ass g (Initials) Any inquiries about a contractor or subcontractor relating to a registration should be directed: Director • Home Improvement Contractor Registration • One Ashburton Place, Room 1301 • Boston, MA 02108 or call (617) 727-8598. —go to page 2— 3 uotum asinn�axpo io asodina s81uv) W r.. a� •�, - - ADITAMlasxBe� ou asB asatjy 'S�Iy �m a�Ium 30 2IZNtItl'I�SIa aHtl K .�v.bi1n►. • .� STAPLE ON SKETCH o Q um j<Na4zcr� rsl( �' Will �QuuL S,�e�xla„�j G.L.,oss K� oaf APPROXIMATE INSTALLAa11U FRAME AFTER PERMIT RECEIVEDRED (WEATHER PERMITTING) ELECTRIC Yes No 2ND Floor Yes IVC) CUSTOMER INITIALS WALL FLOOR HANGPOINT TYPE: MEASURE Rev. 1/10/02c/mickeyTobfolder/eg Page 3 PRODUCT AIIView: AVR AVI FAA CA5 ROOF TYPE Foam OSB Existing Wood ComfortView: CV7 CV8 CVC ROOF STYLE Single Sloe Gable PROJECT Room Porc Prime Door ROOF THICKNESS 3" 6" Under A Roof ROOF PANEL COLOR WH SS MRP Yes (Bug Proof? Yes o CEILING COLOR WH SS I -BEAM COLOR WH SS ROOF ONLY Yes o Type of Posts SCREEN ONLY Yes o GL Later? Yes o WING PANELS Wina T e FoamGlass None WALL COLOR BZ SS Total uanfi of GI_s Win Lites Wina Color H--BZ SS APPROXIMATE WALL HEIGHT 6.5 7 7.5 8 MOUNTING OPTION POCO BREAKFORM House Fascia Reverse Canti ver Dormer Deck Ede No OverhangLen th Existing Header Yes IU Existing Kneewall Yes o CEILINGHEIGHT Posts Ye No Is cgiling fan considered? Yes No Other Approximate han oint DOORS Glass Screen BEAM Ride dross None Total Hei ht of Door (M/F) ro C Type 6" AL 8"AL Wood Lami Other Key Lock Yp,5 Unit(s)Interior color/finish Fixed Tran Yes Height Split Transom Y FASCIA COLOR WH Bt SS Build Down Y Height Line w/existing walk Yes GUTTER- Yes Noj ColorWH WINDdWS Glassm nt Tot I Height f Window DOWNSPOUTS Quatit to GradeTie-in Fixed Tran Yes U Height Split Transom Yes 99 SHINGLESYes No Color/Type Build Down Ye Height ROOF PANiELS Yes No Quantity HANDLE COLOR H L SS Brass Tyge of Glass TdmplTemp Tem /L mi GlassTint BZ/ G AZ/SG KNEEWALL Color Wf4te Sandstone Foam lass Wood Existing Other Kn ew II H i ht Id " SKYLIGHTS Split Glass KW AreNo Vented Yes No Quantity Color Mite GLASS TINT L BZ AZ SG500 GRP/SKY LOCATION CL BZ/CL AZ/CL CL/SG500 BZ/SG500 AZ/SG500 SALES NOTES CL/SB60VT BZ/SB60 AZ/SB60VT STORM/HINGE DOOR Z Yes No T e Size CQ18,r Above Storm Door ZKoam Glass None PRIME DOOR: Size x Existincr.eoening Yes No CARPET Yes No Carpet Size Carpet Color Rev 1/10/02c/mickeyfjobfolder/eg Page 2 1. 20.00' 6.150.00' 2. 22.25' 7.458.67' 3. 175.04' 4. 106.00' 5. 244.22' '\ H K CEATIFIED 7Q a& 4 Y8. Vr e easement OTE: This mortgage inspection was prepared pacifically for mortgage purposes only and a not to be relied upon as a land or property ine survey. Building location and offsets hown are specifically for zoning determination m y and not to be used to establish property inau. The land shown hereon is based on oferenced information noted and may be subject ofurther takings and easements. Northern a.ociates, Inc. accepts no responsibility for images resulting from said reliance by anyone then than the said mortgagee and its assigns in unnaction with its proposed mortgage financing n Raid mortgagor. screE 36'+/- i 1 1 38'+/- 1 1 1 porc deck # 4 -2 STORY WOOD LOT 59 This mortgage inspection was prepared in accordance with the Technical Standards for Mortgage Loan Inspections as adopted by the Massachusetts Board of �f Mq Sf Registration of Professional Engineers and Land r 4C'� Surveyors 250 CHR 605. CARMEN 1 further state that in my professional opinion that G I^ the structures shown conform with A. the local zoning horizontal dimensional setback TESTA ,;, requirements at the tine of construction or are No. 18487 exempt under provisions of H.G.L. CH. 40-A Sec. 7. QQ a Property/House is not in a Flood Hazard. !.Property/House is in a Flood Hazard Area. 7.Information in insufficient to determine Flood Hazard. /� 9sA rlood Hazard determined from latest Federal Flood Insurance Rate Hap Panel Z Saeo d — 47 G Date 4'� L — ; z z AMP, 01, 3 0 { o i 0 m m QL0 r - _ m t'4 M o 7 0 c n , C A o r. 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