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HomeMy WebLinkAboutMiscellaneous - 415 MASSACHUSETTS AVENUE 4/30/2018 415 MASSACHUSETTS AVENUE 4/46 -- - `- -- - - -- - ---- -� 210/045.A-0043-0000.0 J I J � \ 1 Date.............. .............................. .f OF NORr . TOWN OF NORTH ANDOVER O � p PERMIT FOR GAS INSTALLATION 8$wcMvs� 4 This certifies that.. >..... .A. \1......... r ..... ..............r!.(/1,g�+�1,...Y��C"o 1 has permission for gas installation ...........rr ►, 1.c_s..................................... inthe buildings of.. ........................................................................... at........ .....•!".1 ....... '--..................... North Andover, Mass. �.Fee..•' ........... Lic. No. . '1 ...... M .................................................. GAS INSPECTOR Check# 8924 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 3 CITY ! � j MA DATE /®/l S// PERMIT# JOBSITE ADDRESS .__ S 5. OWNER'S NAME �_Ta ,04 ,cli S GOWNER ADDRESS TE b'C -Pa c? L.IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL( EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:[j REPLACEMENT:RI PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER —T1,L _ _. . . _ E::j - -- 1 _ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _ FURNACE v1 _ GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 1 ROOM/SPACE HEATER I __ ROOF TOP UNIT _ TEST r UNIT HEATER ^-^� UNVENTED ROOM HEATER WATER HEATER . OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO [_[ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY P—q OTHER TYPE INDEMNITY BOND P ,OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. j CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent p�of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME c-S,_L.__ t'r�o ' LICENSE# 7a/ ( SIGNATURE MP 0 MGF- JP X1 JGF E] LPGI CORPORATION Q#[=PARTNERSHIP 0# LLC COMPANYADDRESS CITY STATE[ ZIP O! TEL 7 •2(L FAX CELL EMAIL__ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /O VV FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth oflifassachusetts Department of IntlustriglAccidents Office of Invesfigations 600 Washington Street Boston,M 02111 www.mass.gov1dia 'workers' Compensation Insurance Affidavit:Builders/Contractors/lElectricians/Plumbers Applicant Information /� ! Please Print Legibly NaMe,(Business/Organization/Individual): T /Q. Address: 876 FDS�-i 5,7- City/State/Zip: TCity/State/Zip: /yo,/}n at.D� Ni�t 0 l,Pq 5 Phone#: 7d- -,PFJ'-,?_ Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with 0 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time),* have Hired the sub-contractors 2.M I am a sole proprietor or partner- listed on the attached sheet.x 7. Remodeling ship and'have no employees 'these sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ I 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.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they hire doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. - '(-j�a«(e.�_s Policy.#or Self-ins.Lic.#: ExpirationDate: Job Site Address: S/14ASS /¢U�. City/State/Zip: 14,Av�IrA 0/,N_S Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or oneyear 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. g X do hereby certlo under the pains andpenalties ofperjury that the information provided above is true and correct. - /� 3 Signature: � � ` ' '"t Date Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other "4 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire, express or implied,oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto 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 a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable evidence of compliance with the insurance coverage required;' Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill,out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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 maybe submitted to the Department of Industrial Accidents for confirmation of-insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' . compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials -Please be sure that-the affidavit is-complete-andprinted legibly. TheDepartrrieiithas provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license o permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho CoMjAonwoafth ofmassac usotts Dop.artment ofladustdal Accidents �f xec ofIavestigatioxts 600 Wasbingtw Street Boston,MA021I.t TO,#617-727-4900 ext 406 or I.-877-MASS.AFF, I Revised 5-26-05 FaY,#617-727-7749 Commonwealth of Mas usetts Division of Registrati Board bf P/umb' ' •.. THOMA EN ., j 429 WAV o APT 1 o NORTH A ' Journeyma`��,u Q� PL32701-4 05/01/2014 04905 License No. Expiration Date. Serial No. 3 10029 Date .l. q7j13. . . . TOWN OF NORTH ANDOVER sr� PERMIT FOR PLUMBING This certifies that . . 1� . .�1 Q �.�. . - - , - „ - . . - . . . . . . has permission to perform . .� plumbing in the buildings of. _ � . . . . . . . . . . . . . . . . . . . . at . . . . .`.r� . . �- f,� , - ,North Andover, Mass. Fee . a c Lic. No. . . . . . . . . . . . . . . . . . . . . (� PLUMBING INSPECTOR Check# r � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �v[e-_ �` _ MA DATE ? PERMIT# G� JOBSITE ADDRESS (S_ /11)4 5 S OWNER'S NAME e OWNER ADDRESS [_ �•a�/�' ' TEL 4'S`��-,O�r 7/-_ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL EE RESIDENTIAL PRINT CLEARLY NEW: E-11 RENOVATION:Lk REPLACEMENT: 0 PLANS SUBMITTED: YES© N00 FIXTURES 1 FLOOR- BSM 1 2 3 4 5 1 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEMP71, _._ ( _i - .__ I -JE- _,.--,_.-_..1 __ -...I DEDICATED GREASE SYSTEM _...___I _ [ .__._._.__1 DEDICATED GRAY WATER SYSTEM _.-.._.._f ( ^__f __._._.._i _ ._.__._._I 1 _ __ E -__. -1 ____.., f _._._. _I DEDICATED WATER RECYCLE SYSTEM ( ._.._.....__ ._..._._._f DISHWASHER _.._.._-_J DRINKING FOUNTAIN .._.....-_._{ i FOOD DISPOSER i 1 � f I ( .___-._s _.._..____-! __-___ __..__:a .__.._. I FLOOR/AREA DRAIN INTERCEPTOR INTERIOR .._..___... KITCHEN SINK _.. .-.._J LAVATORY _...__-__I ROOF DRAIN _- .____i __J _-_-_____J --,-.J I,-_.__J SHOWER STALL SERVICE/MOP SINK TOILET f tt URINAL _---------f ___i _....... _� I € ; ( ....._._.f i .......-__1 VVA nG MACHINE CONNECTION WATER HEATER ALL TYPES WATE PIPING ___._( ..___ 1 I J=,j _..._- --__. 1 . _ ! INSURANCE COVERAGE: 0 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY © BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the IlMassachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER M AGENT SIGNATURE OF OWNER OR AGENT E hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME i9e _LICENSE# G SIGNATURE ti4P I JP i1] CORPORATION D# i PARTNERSHIP P# LLC sal COMPANY NAME • ; ADDRESS l i — -- of--i ts CITY ZIP 0 (rq TEL - FAX ._____ CELLI __._ IEMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations kwzj. 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lesibly Name(Business/Organization/Individual): 77,&/-.A_9 Address: l� 7 r��e S 7` sit e_T City/State/Zip:_ Nd. tio�a vu' /�,� o( Phone#: cC Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I ' � have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.[WI am a sole proprietor or partner- listed on the attached sheet.# �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. -Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains aan�d penalties ofperjury that the information provided above is true and correct. Signature: Date: 7/ Phone#: 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Informati®n and Instructs®ns Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,- express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto 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 a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided.a space at the battom of t e affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is ou 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 complete this affidavit. The Office of Investigations would.like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877rM.ASS.AFB Revised 5-26-05 Fax#617-727-7749 www.�nass,go��c�a . 1, Commonwealth of Mas usetts r Division of Registrati . Board of Plumbi ti"ra. THOMA N 429 WAV APT 1 c NORTH A ( `q C Journeyma\n'Plu H M S e _ 0 1/20 14 004905 PL32701 J 510 Serial No. Expiration tion D ate. License No. i { i Date.../ .��11.x........ . ..... .1 V&Oprh ? ~�c TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ..................................................:...)......:......... may, has permission to perform ...,�-Q1 lC-iT1 ............................ ........ wiring in the building of............... �CS . E i •• / �c- S rth Andover,Mas at .:..... ..................... ........ .... ..............................,,.,,oFee.A. ........Lic.No.�'5?. M�......................... ...........ICALINSPECTOR Check# f 1702 C) t0'"��' Commonwealth ®f Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 peaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12. 0 (PLEASE PRINTTNINK OR TYPEALL INFORMATION) Date: 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 electricswork described b low Location(Street&Number) S� J � Ownerenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service ZOC)Amps / Volts Overhead ® Undgrd❑ No.of Meters New Service ZO Amps / Volts Overhead® Undgrd ❑ No.of Meters L Number of Feeders and Ampacity O� Location and Naturof Pr posed Electrical Work: � /1� L) 4--- Completion of thefollowing table may be waived by 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 1 No,of Luminaires Swimming Pool Above ❑ In- Elo.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FM ALARMS No,of Zones o ~ No.of Switches No.of Gas Burners No. of Detection and Initiating Devices No.of RangesNo.of Air Cond. TotTons No.of Alerting Devices He t Pum Number Tons KW No.of Self-Contained No.of Waste Disposers J Totals ..._..-""-..-"'....-"......... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: S Heaters Si ns Ballasts No.of Devices or Equivalent s No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications WiringNo.of Devices or E : ` Z e uivalent _ rr-- OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. NF- Estimated F- Estimated Value of Elec Teal 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 ® BOND ❑ OTHER ❑ (Specify:) I certify,sender the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . LIC.NO.: Licensee: 5:'�yy20 Signature LIC.NO.: � (Ifapplicable,enter "er..•Ycofin the license juimber ne.,) H �� s.Tel No.:COr Address: _ =C� 1 .1�' °- t�- Alt.Tel.No.: *Per M.G.L c. 147,s.:)7-6 1,security work requires Department of Public S fety"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(thee one)❑owner ❑owner's agent. Owner/AgentPERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a pen-nit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§ 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed IN Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH PLSPECTION. Pass ? Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: 7-4- Inspectors Si nature: Date: FINAL INSPECTION: Pass M &C 14Failed Re-Inspection Required($.) ❑ Inspectors Co ments: �* }y 1 1 Inspectors Signature: Date: I'I DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com ' a The Commonwealth of Massachusetts Department of IndustrialAccid6its Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please/Print Le ibl Name(Business/Organization/Individua : Address: City/State/Zip: c_Phone Are you an employer?Check the appropriate box: Type of project(required): I.❑ I a employer with 4. ❑ I am a general contractor and I 6. E]New construction pa (full and/or part-time).* have Hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 1311 Other *Any applicant that checks box#1 must also fill 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. tContractors 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 workerscompensation insurance for my e ployees. Bel w is a policy and job�sit_e_ information. / Insurance Company Name:- (`Z / �•� l e- Policy#or Self-ins.Lic.#: Expiration Date: b �. f Job Site Address: 6 " � � U City/State/Zipr'J Attach a copy,of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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. Ido hereby certify unde thepains , dpenalties oth fp jury that e information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto 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 a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture ` (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, ' please do not hesitate to give us a call. The Department's address,telephone and fax number: The Goxnuxa.onwealthofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,IIIA.02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFB Revised 5-26-05 Fax#61.7-727-7749 vWW.m.ass,9oV1dia 9 rCbMIOJWEALTH OF MA.SSACH_USETTS RRG IQU{�NEYMA�J EL�E'CTRI I� q,:'r a Y SUEStTHE ABOVE LICENSE T0:7, 1r ;111E7UAN �r0UNG 3 I h 'f`F H,-,R E-Ali 45�o �z fal ZIS i" Zp 0 Location ' /� Ca-, y�-/Z- Date- S- 14,710. dl� `• MORTN TOWN OF NORTH ANDOVER � 0 No s Certificate of Occupancy $ bis' ZBuilding/Frame Permit Fee $ cro s4CMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14108 Building InUctor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING -777 BUILDING PERMIT NUMBER: ] DATE ISSUED: _ M SIGNATURE. of Buildings Date -D 6 SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Par&I Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Diad Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record f ! Py , V c �Ey� 1 c�5� Name(Print Address for Service ti Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ ;/ 0 Ll i 4,AIII-) 4!7716,0 vee / Licensed Construction Supervisor: �.d �b O License Number Mn Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ ®® Company Name ! ) ��a 9 M P, J/5 / � >�O E n 61 Registration Number ! � 3 C '9 Expiration Date ^ nSignat,re Tele hone !J I i SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) <� Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed W ,"' . SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ��� `� t)F)F'iCiA [ISE O�y ��w` C m leted b ermit a licant 1. Building r (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbinE Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner/Authorized Agent of subject property r Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge- and nowledgeand belief r Pr nit eL— 7 Signature of Owner/A i ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 PD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I f NORTH R over CJ O 7 , _ -y� L Ityo L COCH dover, Mass., /!- y o a c ,DRATED O I G h h o ? ^ H 4 BOARD OF HEALTH " 6 x Food/Kitchen I L � oo I'O '� �� o Septic System R C C ry 7 ILD OD &9 y0 O O L =' BUILDING INSPECTOR C4 c c .........................................../... ................. Foundation ic ................................................. Rough .................................................................... Chimney i to the terms of the application on file in Final ispection, Alteration and Construction of oPLUMBING INSPECTOR L � O y 7 O .` � a �; .:� � Rough '= Of c Final o o S .4THS LU C) ELECTRICAL INSPECTOR x w � � > co I $ a w r= n1. z Rough II a w o o >: p ......................... ...... Service - - ;. . ..... ........ N { '- w BUILDING INSPECTOR Final o wx z wI ° w IJ ° C: y Building _ GAS INSPECTOR Rough Q�a T- ° `s Do Not Remove. Final m one FIRE DEPARTMENT R ling Inspector. Burner Street No. Smoke Det. �P I Town of North Andover 4 NORTH Q t4FD 1 E O Building Department o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 n°RATED hPa t,�S �SSACHUS� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit 4 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a. The debris will be disposed of in/at: ` / nt R Facility location y o» Signature of Applicant g-11216 o Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I DATE( ACORQ� CERTIFICATE OF LIABILITY INSURANCE 10-12-1999 PRODUCERS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INT'ERNZT INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 522 CHICKZRING ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW NORTH ANDOVZR, KA 01845 —� INSURERS AFFORDING COVERAGE '. INSURED NbuREu A "TRUST ASSURANCE DAVID CASTRICONE ----- -- --- INSUNER F 1'1.:JTERN CASUALTY I ROOFING AND SIDING INC - ----�.. -- — - ---- --- -- ..- _- NavNEt+i '7 HILLSIDE ROAD �_INSVItE:c O -- _.- BOXFORD DSA 01921- -- ------ -- - ------- - I IN I�VII I:V!F COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THF INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTNIT,HSTANDIN" ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WI1H RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SL;Cr POLICIES AGGREGATELTR S' OFANGLE S SHOWN MAY 11AVFBEEN POI cY Numsept REDUCED BY PAID CIL4IMS. LIMITS j NSR I POLICY EFFECTIVE POLICY EXrIRAn I GENERAL LIABILITY EACH OCCURRENCE ----__1 -_.J L--_�i OO _ __. A COMMERCIAL MA-OE occuR GENERAt ITCP 1012811 Ut1;UA/1999 08/06/2000 FIRF.pAMA0E on,rr,.I 3 50 UUO MED Exy(Any orro person; -13 _ S: 000 ❑ _ __ PERSONAL a,ADV INJURY IS 1. 000, 00O GENERAL AOOREOATE li -- 1/ 000 000 GENT AGGREGATE LIM1I,APPLIESPER PRODUCTS COMP/OPAOG IS ? UOU, U00 POLICY PRO LOC ----------------_._._. AUTOLIOBIL!LIABILITY —� CCOMBINED SINGLE lll.l l' ANY AUTO (Ee eGCll)ant) ',3 �. ALL OWNED.AUTOS Il INJURY I SONE Ol (P., 1lE0 AUTOS I I (P.r Pe reonl - HIRED AUT 08 I I BODILY INJURY NON11Cti'NEU AV Ob j (Pur PccJoufll) 3 PROPERTY DAW GE (Per ecuo&rr,! 1 '. GARAGE LIABILITY ' AUTO ONLY EA AGGOENt $ I II� ANY A1110 OTHER THAN EA ACC S j 1'I AUTO ONLY AGO 3 EXCESS LIABILITY I I CCV EACH OCCURRENCE R �''��1 ��--.���� RENCE _6 Oc('un 0I CLglMtl MAGE AGGREGATE I �I I oEUUC I IBIS RETENTION s -i 3 VVORKERy COMPEN$ATION AND H EMPLOYERS'LIABILITY ER ---- 13 WC99 A24009 0 1,4),j 1 999 1 U9/23/2000 ;._`,_L EACH ACCIDENT EL DISEASE EA EMPLO)TI51 500 000 _ EL DISEASE.POLICY LIMn s lOC 000) -OTHER ---' -- - I DESCRIPTION Of OPERA TIONS/LOCATIONSN E HICLES/EXCLUSIONS ADDEO BY ENDORyF.MFNT/y VECIAL PROVISIONS ROOFING AND SIDING CERTIFICATE HOLDER iE, ADDMONAL INSURED INSURER LETTER: CANCELLATION SHOULD ANY OF THE AB.OVE'DESCRIBED POUCIES-eE CANCELLED BEFORE T-HE EXPIRATION I I UA I C 7ilf H:Ofl THE ISIJUING'INBURER WILL ENDEAVOR TO MAIL 010' UAyN "PI:t,l,,. !I - NOTICE TO rHE CF.RTIFlCAI-t HOLDER NAMED TO THE LEFT,BUT FAILURE +'O UO SV--LL IM v(JyF NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INy URE R,ITb nOENI-y UN ( HE'PHEyENT AV1/10RIZE S E —� - 4e ACCRD 26.5 (7/97) C PORATION 1988 Umation Date NpRTM TOWN OF NORTH ANDOVER p Certificate of Occupancy $ • ; Building/Frame Permit Fee $ 4 4,,b•�ne•A``h ss�cMuBEs Foundation Permit Fee $ Other Permit Fee $ �21 rj Sewer Connection Fee $ -- , attess c2nlaec t r Fee $ € `,��T�O'f�1G-',CCI.LECTG� $ Siy r � � � /,,�(� _✓ _ r ` Building Inspector I�►A� 2 _ Div. Public Works PERM T�NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP 4-40. LOT NO. 12 RECORD OF OWNERSHIP jDATE (BOOK ;PAGE ZONE SUB DIV. LOT NO. LOCATION 4// .� l/ � ��y PURPOSE OF BUILDING ,! GVH OWNER'S NAME ,n , NO. OF STORIES SIZE ,. OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME vs s SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET ' POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST w! PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT.v EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ,,f ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS -- 1 PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR rEFILED � �., BOARD OF HEALTH IG ATURE OF OWOUR OR AUTHORIZE AGENT FEE D OWNER TELPLANNING BOARD . PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC, d%7 BOARD OF SELECTMEN BUILDING INSP[CTOR BUILDING RECORD 1. OCCUPANCY 12 SINGLE FAMILY 11 STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDWD —_ —— PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M TAREA _ '/ 1/2 3/. FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK N MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE 1 IP BATH (3 FIX.) ' GAMBRELMANSARD TOILET RM. 12 FIX.) ~ FLAT 11 SHED WATER CLOSET _ t ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &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 _ ELECTRIC 1st 13rd 11 NO HEATING �1 1 COMMONWEALTH MPAH;MtN 1 OF NUb JC bAht I Y 1010 COMMONWEALTH AVE. OF BOSTON,MASS.02215 MASSACHUSETTS ENCLOSE CHECK OR MONEY ORDER i LICENSE FOR REQUIRED FEE, EXPIRATION DAT f-4.r.1Lr.✓`�' I CONSTR. SUPERVISOR 06/30/1993 MADE PAYABLE TO RESTRICTIONS o EFFECTIVE DATE LIC NO. NONE 06/30/1991 022680 "COMMISSIONER OF PUBLIC SAFETY" ARTHUR J WALSH JR = (DO NOT SEND CASH). 55 PLEASANT ST SS N 013-30-8376 : IN ANDOVFR MA 01845 P4EASE NOTE FEE INCREASE PHOTO(BLASTING OPR ONLY) FEE: 100.00 EiFECTIVE FEB. 1r 1989 HEIGHT: f NO.'VALID UNTIL.SIGNED BY LICENSEE AND OFFICIALLY STAMPED -OR-SIGNATURE OF THE COMMISSIONER DOB: 06/09/1939; D NOT DETACH LICENSE STUB _. THIS DOCUMENT MUST HE SIGN U E OF LICENSEE « SIGN NAME IN FULL-ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF THE HOLDER WHEN ENGAG' -' OTHERS.-''RI(iHT�;THII,MB,�PRINT, ED 1N THIS OCCUPATION COMMISSIONER 20OM-2-87-81429 HOME IMPROVEMENT CONTRACTOR Registration 103358 Type - PRIVATE CORPORATION EXPiratiOn 07/07/94 A. J. Walsh 3 Sons Arthur J. Walsh 55 Pleasant St. ADMINISTRATOR N. Andover MA 01845 A.J. Walsh & Sons Inc. 55 Pleasant Slrcct North Andovcr, MA 01345 Mass. I.10ENSE # 022690 Mass. REGISTRATION # 103358 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home Improvement contractors and subcontractors engaged In home Improvement contracting,unless specifically exempt from registration by provisions of Chater142aofthe generallaws,must beregistered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Nome Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108. Designated Registrant's Name: —__—__--- Registration Number: Salesperson's Name: This agreement is made on_�11 64,GZ /0 y Z. between (DATE) (CON7R OR 1 ji Of c�� //f � j (S�j e—lc �•3,` -llcLlc.t, (ADDRESS) (P11ONP.NUMBER) hereinafter called"Contractor'and ' ��Jl�% _/ 7 ��► l (OWNt7t) of �i v 7 (ADDRESS) (PHONE NUMBER) hereinafter called"Owner". DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contractor agrees to perform in a good d wor manlike manner all work detailed below. Such wornsistc of the-following: C t t rtl:t - -�c. DETAILED F.SCRIPTION OF MATERIALS TO BE USED VV Materials to be used in perf rming the above described work consist of the f 11 in H. PRICE ' .=– Contractor agrees to do all work described in Section I for the total price of 5 W. PAYMENT Payment will be made as follows: 12.3.1m%(S )upon signing Contract; %(S )upon completion of ; =%(S )upon completion of , and the remaining *(S71 )upon verification of the work by Owner and Contractor as haviftg been satisfactorily completed,which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount or all deposits or payments which the contractor must make, In advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount is greater. IV, COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the ri�terials fore a third day following the signing of this Agreement,unless specified here in writing. Contracwr will begin work o ora ut >/'IL�C:4 64 (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by � (date . The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. NpRTfq TO" of �� over z - t o� `Coc�,� ;9rt dover, Mass., 0.4 'aA 19PS ORATED ' '9S H E� BOARD OF HEALTH Food/Kitchen Septic System . PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT......II.:I... .. ..... .A .........r. . . .'a.......................................................... Foundation has permission to erect.c.1,.0LTw Pbuii gsson ........��.S..M& f.���................. Rough to be occupied as...........�.1.01AN-110.......*...fto1.0... .&W.. ..............................I............ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating.to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ..... . ... ... .. . .. ........ ... 4" Service BUILDING INSP e6i Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F nagh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT - Burner PLANNINGFINAL ��s6 CONSERVATION FINAL Street No. Smoke Det. CFIIUFR /WATFR FINAI. K9 yS DRIVEWAY ENTRY PERMIT