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Miscellaneous - 42 CHURCH STREET 4/30/2018
-42 CHURCH STREET i � 210/042.0-0003-0000.0 / Date..���. .�. .. �.`..1.............. Y OF p►ORT�y,� TOWN OF NORTH ANDOVER ,► ; n PERMIT FOR WIRING CHU This certifies that ..........� J<�Q1....... .. .F.. S .............................................. .... Yn e4 RS hds permission to perform ....... .......` ..'��..... . !.:..r.�!. ... ....�T.. .... '}' >'1. wiring in the building of.... .............. .::!.,t.`.., .............. ......................................................... a 1 at .1�..-.q (,.�:I V c� �� �� *;212 f- k North Andover, Mass. ............................................... fee..)A(� ...........Lic. No.1.1.�12- �`�} .............. ... ............ ......... .............. .... q ELECTRICAL INSPECTOR Check# I - v e c" '. Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 12:4� Occupancy and Fee Checked ,M BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL)NFORMATION) Date: (�_ /a - / City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) q a Al 4( L 1A ua(V,,- S 1 Owner or Tenant Telephone No. Owner's Address sokvA E Is this permit in conjunction with a building permit? Yes ❑ No ❑' (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Loo Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service WO Amps 115-/);O Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed EIectrical Work: ke t < < �( (, —,X q 5coNVn0 Wi; R Gov i�< Gc16Si�Q Completion of thefoNwing table may be waived by the Inspector of Wires. Trans No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA = No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices 4 No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ..................................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Dr Heating Appliances KW Security Systems:* 3' No.of Devices or Equivalent No. of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Eq uivalent �- No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: �. Attach additional detail if desired,or as required by the Inspector of 97res. N 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. �•J 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:) Icertify,under the painsand enalties ofperjury,that the informatio on this application is true and complete. FIRM NAME: _ �r Dion i� �Ir"'� �� C A LIC.No.: I 0 I Licensee: jQ'�V,0 k\-c 55--C Signature LIC.NO.: (If applicable,enter "exempt"i he erase number line.) , (� rG ��� Bus.Tel.No.•_ ( Address: � y ok G.NN 5 W � Alt.Tel.No.: g 1 17 *Per M.G.L c. 147,s.57-6f,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 -1PERMIT FEE- $ Q`o 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 1 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 permit 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 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed '❑ Re-Inspection Required($.)❑ Inspectors Comments: f, At Al L Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed ❑' Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors gnature. Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com r The Commonwealth of Massachusetts Department of IndustriglAccidents Office of Investigations 600 Washington.Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: Mad 11 t�� JA\4 e�7 City/State/Zip: Phone#: Are u an employer?Check the appropriate box: Typo of project(required): 4. ❑ I am a general contractor and I 1. I am a employer with g . 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 7. Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152,§ (4 1 ,and we have no ) 12.[]Roofrepairs, insurance .re uiredemployees.[No workers' required.] 13.❑Other comp.insurance required.] Mny 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 aie 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 the,policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: ` ExpirationDate: Job Site Address: `rte City/State/Zip: Attach a copy of the workers'com ensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certFX u r the p i s and penalties perjuryfiat the information provided above is true and correct. - Simature: 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 Instruction's 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 ofits political subdivisions shall enter into any contract for the performance ofpublic 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 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(ifnecessary)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 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 Car=onwoalt� ofMassachusetts Department of fadustr%al Accidents Office of Investigatiom 600 Washington Street Bastu MA 02111 `QL#617-727-4900 ext 406 or 1-877,M.ASS.A,FE Revised 5-26-05 Fax#617-727-7749 WESTON MA 02493-2026 Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS BOARD OF EL CTR I Cl AN ; ISSUES THE :FOLLOWING LICENSE AS..:::A R'EG 15TRED MASTER E,LECT.R I`C1 AN NEW ENGLAND ELECTRICAL COr JOHN W ALESSE 118 NORTH AVE / Z / U 26' WES:TON M4 02493-20 F 11012 A o7%31/;]>6 29430 Date..`.�Izt,.o........ TOWN OF NORTH ANDOVER 03?• `` •• oos PERMIT FOR PLUMBING a ; ,: • { This certifies that 1�................ ................................................. has permission to perform........I)i ...............ONCa�=....................................... plumbing in the buildings of. . .. �. •�� at......... 'T�... `..E..bf-, —...................I North Andover,Mass. Fe ..... "....Lic. No. 2�?�'f'.I.. ...s .k........................................................... PLUMBING INSPECTOR Check# " l y, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: t / N!X /_V()✓' � ? eve� ,MA. Date:- Permit# Building Location: / /-/ Cf LNCIA St Owners Name: /I 4d,Ale JJ 114100 IrType of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No FIXTURES DEDICATED SYSTEMS LU p Z v V H 0 C W � z Q N V ~ O C z 1z Y y Q WLu LU Z a H = a Z W Z H h a y LUQ C O �°� Q 12 = Q Z O W Q LU oZS 3 aa H H o o O x o Q a a v- a: o: Q x x 3 g o: y H 3 3 3 o a to 3 SUB BSMT. BASEMENT 1 T FLOOR Q. 2ND FLOOR 3 RD FLOOR 4T"FLOOR 5"FLOOR 6 FLOOR fm FLOOR 8 FLOOR /� Check One Only Certificate# Installing Company Name: /T I Vel �� `t deg��Ij �- S 7'G1� h /1 d /4"dovef' ❑Corporation Address: � City/Town: State:�/� rr ❑Partnership Business Tel:`'/�Fj ��cy " 1�,��9 Fax: ❑Finn/Company Name of Licensed Plumber: Int C h Q e/ ,d- 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 have checked Yes,please indicate the type of coverage by checking the appropriate box below. A 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 Massac se General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ i nature of Owner or Owner's Agent 1 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 1422 of the General Laws. By Type of License: / �✓�/ v-�( Title ❑Plumber Signature of licensed Plumber City/Town []journeyman License Number: APPROVED OFFICE USE ONLY) The Col:nmonweaN k ofMassacliusetts DgpanWientof lndusirialA aUents Office of Investigadons 1 Congress eS M4&4(i 100 Boston,MA 02114-2017 s�iv�►vrnassgovldia , Workers'Compensation Insurance Affidavit:Btu'Dders/6omtractors/Elect>ricianslPlumbers Ayufieant bformation Please Print]Leaibiv Name(Business&pnizationll dMdual): 1ye/S 1"�� 't �e� ^'S Address: S( 7!7X T(( /'S City/State/Zip: da.,�x1-1V 01 l 0 Phone#: 7 .Are you ant employer?Check the appropriate box: Type ofIproject(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling slip and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Biding addition [No workers'comp.insurance comp•inst ranee.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' camp. right of exemption per MGL 12.❑Roof repairs insurance required.)t c.15%§1(4),and we have no 13 ❑Other employees.[No workers' comp.insurance required] *.Airy applicant that checks box 91 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 eonanotors must submit a new affidavit indicating such. :Contractors that check chis box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.lithe sub-mittractors have employers,they roust provide thele workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site ir�orrttation. Insurance Company Name: Policy#or Self-ins.Lic.0: Expiration Date: J Job Site Address*, I C�iJY-C h city/State/zip: AUd bye.-/V/ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failme to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a Eno up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the faun of a STOP WORK ORDER and a fine of up to$2250.00 a dsy 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 Iiereb cerdh ua the pahis penables of peduq that the m orumdon provided above is tnte and correct. ......... 9 — phMe O fit:fal use only. Do not write int this area,to be completed by city or town officiaL City or Town: Perrnit/.License# Issuing Authorw(circle one): 1.Board of Hean I Building Departtment 3.CRY/Town Clerk 4.Electrical bspector 5.Plumbing Inspector 6.Other . Contact Peraon: Phone M. f �I PLI� ERS. 0 G�kSFITT€ S F i SSUES THE F0LlOW1 -CENSE L 1 CEAI E I ► A J 0' EYMAN PLtJl r� $ FOXH i L 3A Kid lER M 01810 16�� "` �. TO DATE//..`. jv AM - -� PMi P FROM PHONE( ) HOF CELL 0 FAX 7fl_'0 / 1� '8 ( 3-1E E ;-,� q' ©0 8 F. A G F - -- -� O i EiMAIJDDRESS SIGNE PHONED BACK C CALL RNED uWSEE YOUO AGAIN ALL rl 1WA L' 1 RGENT r TOWIN OF NORTH ANDOVER Office of theIluilding Department Community Development and. Services 27 Chries Street Norih Andowr,Massachusetts 01845 Art. D. Rolfxrf Niccl ta, Telephone(979)688-9545 Buildirrg Commissioner F-AX 978)698-9542 October 30, 2003 Mr. Chuck Papalia 24 West Bradstreet Road North Andover, MA 01845 RE: Landscape Business at 42—44 Church St. Via Certified mail, return receipt Dear Mr. Papalia: Per our conversation on 10/29/03 please allow this letter to serve as a CEASE AND DESIST for the operation of a landscape business at the property located at 42—44 Church Street. Please be aware that this type of business is not allowed in a residential area, as you will see by the following excerpts from the Town of North Andover Zoning Bylaw. Please contact me upon receipt of this letter so that we may begin the process to remedy this violation. I may be reached at 978-688-9545 between the hours of 8:30— 10:00 AM. Respectfully Michael McGuire Local Building Inspector a 2.40 Home Occupation(1989/32) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use of the building for living purposes. Home occupations shall include,but not limited to the following uses; personal services such as furnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing of goods,which impacts the residential nature of the neighborhood. 4. For the use of a dwelling in any residential district or multi-family district for a home occupation,the following conditions shall apply. a. Not more than a total of three (3) people may be employed in the home occupation, one of whom shall be the owner of the home occupation and residing in said dwelling; b. The use is carried on strictly within the principal building; C. There shall be no exterior alterations, accessory building, or display which are not customary with residential buildings; d. Not more than twenty--five (25)percent of the existing gross floor area of the dwelling unit so used,not to exceed one thousand(1000)square feet,is devoted to such use. In connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible from the street; f. The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance,emission of odor,gas, smoke,dust,noise,disturbance,or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no feature of design not customary in buildings for residential use. 11. Commercial vehicles in excess of one (1) ton capacity shall be garaged or screened from view of residential uses within three hundred(300)feet by either- a. ithera. A strip at least four(4)feet wide,densely planted with trees or shrubs which are at least four(4) feet high at the time of planting and which are of a type that may be expected to form a year-round dense screen at least six(6)feet high within three(3)years,or b. An opaque wall,barrier,or fence of uniform appearance at least five(5)feet high,but not more than seven()feet above finished grade. Such screening shall be maintained in good condition at all times, and shall not be permitted to exceed seven feet in height within required side yards. Such screening or barriers may be interrupted by normal entrances or exits and shall not be required within ten(10)feet of a street lot line. Garaging or off-street parking of an additional two(2)commercial vehicles may be allowed by Special Permit. 10.13 Penalty for Violation Whoever continues to violate the provisions.of this Bylaw after written notice from the Building Inspector demanding an abatement of a zoning violation within a reasonable time,shall be subject to a fine of three hunched dollars($300). Each day that such violation continues shall be considered a separate offense.(1986/15) v SENDER: I also wish to receive the follow- 'N ❑Complete items 1 and/or 2 for additional services. ing services(for an extra fee): y Complete items 3,4a,and 4b. ❑Print your name and address on the reverse of this form so that we can return this ai card to you. 1. ❑ Addressee's Address 2 a) ❑Attach this form to the front of the mailpiece,or on the back if space does not permit. 2• ❑ Restricted Delivery iA t ❑Write'Return Receipt Requested'on the mailpiece below the article number. ❑The Return Receipt will show to whom the article was delivered and the date CL. p delivered. d 3.Article Addressed to: 7002 0510 0000 0894 3278 E l=. 4b.Service Type', v „i� ❑ Registered eFiifled w �1 2yLc c��j rn r1� t ❑ Ex ail ❑Insured N N eturn Receipt for Merchandise ❑COD 7.Date of Delivery L O 5.Received By: (Print Name) 8.Addressee's Address(Only if requested and m r c fee is paid) c y F Ignature(Addressee or g nt) rm 3811,December 94 102595-99-8-0223 Domestic Return Receipt INbPhU 1 UK'b WAILY r1UU I c rtr-rvn I Date INSPECTOR Odometer Readings Last Stop Office The following is a correct listing of my inspection activities for Miles Driven this day. Permit, Equip- Type of ect- Stop Arrive Left Address Notice or ment Ins Complaint or p Number Buildin ion j � 1�i s t ►2 Q N0 I too`tr 2 _ Yl14 R K P-,P, �e �rr�14 C-k f% C deli-4 3 4 .0Lhnt �� 5 4N1W*rr01 /1fYl/k��1 �!ut -z- 6 h,4 u, V is i Ac d 1,7[f-c 7 6>CIS S I�N 5 . ti �u rti e m 5 c eNr S g 10 . w 4,C- h.�.l 12 S WA A 19-W4 r-e- 71t Ut— - 13 r 4-c, V I v t ti Ivo r v al e 14L4 ,v�,�,, S �`e D �a J�' �`�1 S�i•c s .v c) 15- -- --1 -3-` — k° ✓f Y--A'c A/'d I- i` S o vs — 16 "4 4- S A,e/ WA-.r u of r �4 17 h�e a- / f /V 0 4- r j UN rod �O 18 aN I % IQ fit- J15 l7, 19 A4 v •--t s tiJ /D 21 _ - _ WNit -d7 $ , b S/Nc - 22 23 -e ea Ale- 24 —- - l �e �m Ci4 - L� ° n ►'tee c e c d> !C Y� Lt�Lt r C rt 25 � ra- ,�, pi• Cr u-es ® a w ,[�3nv-DS f � /2C� 45 P1114vS O u' r9� ``-, WORK DISTRIBUTION (KINDS OF INSPECTIONS) 0 WV / PERMITS PERIODICAL & .FEE REINSPECTION COMPLAINTS NO ENTRY TOTAL CHECKED BY DATE SUPERVISOR September 26, 2003 Michael McQuire Building Inspector 27 Charles Street North Andover, MA 01845 Dear Michael, Per our conversation around the end of July 2003, I am writing a formal complaint against the owners of the property at 42-44 Church Street,North Andover. This property is owned by Charles and Susan Papalia. They own 8 properties in the Andover/North Andover area,most being rental property and Susan is a real estate broker. I am sure they are well aware of zoning laws and nuisance laws but feel that they are above reprisal. My family moved in to 34 Church Street directly next door to the Papalia's property in May of 2003. As soon as we moved in we began to have problems with Charles Papalia Jr., owner of the landscaping business that is being run out of the driveway at 42-44 Church Street. Charles Papalia Jr., is neither a tenant nor the owner of the property at 42- 44 Church. Charles Papalia Sr. is simply allowing him,to operate his business out of the residential property. Every morning around 6:30-6:45 am Charles Jr. arrives at Church Street with his crew of two other men and the noise begins. He and crew begin by starting up the 1981 landscaping truck(with no inspection sticker). This vehicle is extremely noisy and pollutes the air. The visible fumes travel directly in to my windows and my home is saturated with gas and carbon monoxide for approximately 1-2 hours every morning. The procedure is repeated every day around 5-7 pm when the trucks arrive to be put away at the end of the workday. Charles Jr. states that he must leave his truck running that long"to warm it up"because it is constantly stalling out. He also tells me that his truck"is so old it doesn't require an inspection sticker." In addition to that truck, there are two other pickups left running in the driveway, one red and white and one blue. In the morning the crew arrives and starts making a lot of noise talking, fighting and barking orders to each other as they maneuver the trucks around and begin moving the equipment on and off the trucks. Then the gassing up of the lawn equipment begins. Weed whackers, lawn mowers etc. all running before 7 am every morning, seven days a week. My family has been made physically ill by the fumes and the mental distress of the constant noise is more than anyone should have to bear. In addition, the driveway is filled with dangerous potentially hazardous materials, and there are children and animals living and playing around all of that. Not to mention the sight of all the junk, trash and tools that are kept outside in the driveway as if that driveway is some sort of storage shed or storefront. I have pictures and videotape to prove my point. We have spoken to Charles Jr., Charles Sr. and even Susan Papalia about this problem that has been apparently ongoing for years. Their own upstairs tenant, a Mr. Silk, personally visited my home one day to "shake my hand" for yelling at Charles Jr. Mr. Silk stated to me that he too has begged that the noise be stopped because of the distress it causes his family, and he told me that there has even been physical confrontations between he and Charles Jr. "I grabbed him by the neck one day because he just doesn't understand regular conversation."Mr. Silk also stated to me that he would be willing to speak to anyone official that I brought in on this situation. The Papalia's have shown a true lack of regard for the neighborhood and the health and safety of its residents. Both Charles Sr. and Susan Papalia have been contacted by several neighbors, including myself, and yet refuse to yield to common decency and respect. They don't have to live in that neighborhood and they don't care what suffering they are causing. I guess they feel that they are above the law. I'm hoping that the town can show them that they are not. Charles Sr. told me that his son"has an office" at 42-44 Church St. When I asked him if his son had any commercial permits to run a business out of that "office"he hung up on me. Because I have made complaints, to my landlord and the police, Charles Jr. has begun retaliating against my family. He has put nails in the driveway behind my vehicles. If my husband had simply backed out of the driveway that day without looking behind the car, he may have been killed by a car accident caused from the damaged tires. As far as I'm concerned that little act of vandalism could be construed as attempted murder. Charles Jr. keeps unplugging our cable connection from the box outside our house. The vandalism has become so bad that we have set up video surveillance of the home when we cannot be there. Take a look in my kitchen window and you will see a video camera looking right back at you. The police have been called on us no less than five times, all phony complaints, meant to irritate us. There were never any violations of law found; no one was ever arrested, no reports written. Yet they continue to be called to my address. The police are becoming aware that this is a game being played but they say there is nothing they can do about it. It appears that Charles Jr. is quite friendly with my landlord and their best friends who live next door to me. They have gotten in on the act of retaliation as well, even contacting social services because they knew I had a child and thought that would be the best way to get back at me. I had to put up with a horribly intrusive investigation of my family because of the false complaints that my husband and I were "yelling at"my daughter. I cannot put into words the way that I feel about that. Needless to say, I was given a letter by Social Services that said they found the complaints to be without merit, and they apologized to me for having to do their job,but no one can give me back the dignity I lost and the trauma my child was put through as a result of that investigation. Not in this lifetime or any other. I have recently found out that Charles Jr. was cutting the grass at 34 Church St(my home) for free because he is aware that he is breaking the law and causing a nuisance and that is the payoff for my landlord putting up with the noise and pollution. Up until now, my landlord has been lying to me and telling me that they were paying to have the grass cut. Mr. Papalia himself has confirmed that to be false. We are currently addressing this issue with an attorney as quite clearly, our landlord knew this was a problem and not only failed to disclose it to us,but they have consistently refused to take action to stop it despite repeated complaints by us. Because they are now and have been friends with Charles Jr. for years. That is a separate issue from this but it may help you to understand why my landlord is not the one writing this letter. Also please keep this bit of information in mind when you speak to Mr. Papalia, as I am sure he will tell you that the neighbors on the other side of my duplex don't have any problems with him. They are being well taken care of for their silence. They live in that side of the house rent-free because they are also friends of the landlord. They would never say or do anything that went against those interests. At 42-44 Church the only tenant who may give you a straight answer is Mr. or Mrs. Silk who live on the second floor of that residence. You must realize however, that they are at the mercy of their landlords (Charles and Susan Papalia) for anything they might say. The person on the first floor is Charles Jr's brother, who is also operating a limo business out of that property and it is unlikely that he will be truthful either. I was unsure how much of my story I should include, as my only real goal in this is to get the fumes to stop pouring in my windows every morning. I don't want to wake up every day and have to listen to the noise and smell the gas. It's making us miserable and sick. I'm having trouble breathing and have developed a weird cough that won't go away. My daughter is complaining of headaches and nausea. But, I feel that it is important that I tell the whole story because I don't want you to think that I am hiding something or that I am simply doing this in retaliation. This is a serious health issue and it should be addressed. Is it okay to just set up a landscaping business in any driveway you choose?No permits, no regulations for noise or the disposal of hazardous gases? Especially when you are neither the owner nor a tenant of the property? Charles Jr. owns a spacious home at 24 W Bradstreet. It's about a block from Church St. Why can't he park his vehicles and conduct his business there? My guess is the neighbors on that particular street would put up with that bull^%$# for approximately 2 seconds before filing a class action lawsuit. Does Mr. Paplalia think it is okay to cause this kind of nuisance on Church St. because the house values are lower? He is certainly doing his part to contribute to the lowering of everyone's property value on that street. Susan Papalia, as a board certified realtor should know better than that. We have tried to grin and bear it. We have tried talking nice, begging and even yelling and threatening legal action. It has all fallen on deaf ears. We didn't want to have to move so we didn't do a lot of things that we should have, like writing this letter 6 months ago. My landlord has threatened us with eviction for writing you this letter but we no longer care and have decided to move anyway. Its' not worth our health and sanity to keep quiet any longer. I appreciate your time and attention to this matter. Please feel free to contact me at any time on my cell phone with questions 617-968-8656. Sincerely, C 'sting Keene G� 34 Church Street North Andover, MA 01845 TOWN OF NORTH ANDOVER OFFICE OF THE BUILDING DEPARTMENT COMMUNITY DEVELOPMENT AND SERVICES 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 D. R.N.icetta, f NaRTH Building Commissioner � Telephone(978)688-9545 0 - p FAX(978)688-9542 4SSACHUSE� FAX TRANSMISSION TIME: `�� DATE % "%8 3 NO.OF PAGES TO: U1�,�GQ� ��q FROM: V�j t -m m/l SUBJECT: aA^ P Gi(A> 4 L-e-H�r BUILDING DEPT FAX NUMBER 978-688-9542 To Fax# ,- 9'" ( S — REMARKS: la S :v S�-e cn .� co L( D f6 : J,eC'C' l u^e (,-"e Lf V C.ku r c BOARD OF APPEALS 688-9541 BUILDINGS 688-9545 CONSERVAT10N 688-9530 HEALTH 688-9540 PLANNING 688-9.535 INSF'tU-I L)K'b uHiLY MUU I IM r r-rUn I ./y!'n/Ul n9 C64,— Date - INSPECTOR Odometer Readings Last Stop Office The following is a correct listing of my inspection activities for Miles Driven this day. Permit, Equip- Notice or meat Type of Stop Arrive Left Address Inspect- Complaint or Number Buildin ion CA l I Igo 4.1 _ 2 YY1 4 R K 2'¢p Srr Q rc�r Gov At S 3 7 C-k v r c Ll - 4 'A II, r-- 5 .' AroIW#rr W /1 �1i"I"+ i 1 0 - �h h 24- .6 6 h A V z ✓/S Ac a/ sl7'-c- a.� s,e .e r,;- 7 -;7 mV S I0N5 e,:Yl M5. ti ref 8 P40,-- c.,,!/ 1J I m-aq-0 3 P g -+ 500)(-'t Y r a y- L - '/4 -R m v 11 Scy-eda / i. cc �tl_4 W 12 S h �2 Gt/R S 1'9-W4r�e Y-A'u - ,v cr�p �a 13 e A-e�V, e'er a l N z ti rev 116 14 -5•t�a� 5 10e_ ,o }� 15- -- —�-�_yJ k O ✓ 'h`G IGS �e' l- I SO/V s — 16 8,,T "4 -A S `G wA Y` T 17 h�e a f his N a f t%S 0ti rW -Jo 18 a N Z b y c a t/s mr A c Wr r f — 20 --- ———i.-6' /K—'� -- '�< tl e Cl w•�k - eG 0 c-%t P4 Aa l 1k 21 - 22 —f PvA3I�1--c1,�—i4rv�¢r-c y-1.14-� 23 ---- - -- p 00,rra A .0 x 24 —- - !�e /m CA _ 0 000 ^' rNe C�e44-Arc 25 S 5 e-4,1 is- o -o ���vr� f-le - WORK DISTRIBUTION (KINDS OF INSPECTIONS) PERMITS PERIODICAL & .FEE REINSPECTION COMPLAINTS NO ENTRY TOTAL CHECKED BY DATE SUPERVISOR ITR BUILDING PERMIT ��( �I�j o`"°F. 6 TOWN OF NORTH ANDOVER ° : APPLICATION FOR PLAN EXAMINATION - Permit No#: vy Date Received �gSSACH05���y Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION l�,,w�,_�e_ Print PROPERTY OWNER ''" ""��`- vnP,-1 Print 100 Year Structure yes Pno MAPC; PARCEL: �ZONING DISTRICT: Historic District Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: &Y-a— Phone: Address: '-b-',4� /;z, 4c.+o V,i Contractor Name 6 uih' ' W�lone: Address:2,1 �2 c.�1{- /'v,,� zz,t 0 Supervisor's Cons ruction License: Iy, (15% Exp. Date: Home Improvement License: I& Exp. Date: / 7 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �3 FEE: $_ i Check No.: Receipt No.: NOTE: Persons contracting with un ' t contractors do not have access to the f nd Signature of Agent/Owner ignature of contractor - I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinnning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS L Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe:Building Permit Revised 2014 Location 42— w No. t;� t�1 vy Date . - TOWN OF NORTH ANDOVER • c.'�1 n t�6' • • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check#bbi"� uilding Inspector � NORT1y Town of A o - . 10 No. - �` C, h ver, Mass, A4tna6�5 o COC MICMlwIC It 1_01 A0RArEo PP '�y S U BOARD OF HEALTH Food/Kitchen PER I Septic System THIS CERTIFIES THAT .......... ... .. . L D BUILDING INSPECTOR T%Ia.......... . . .... ............. ... ..................... :4 has permission to erect .......................... buildings on ... Foundation Rough 10 to be occupied as A . ..III �.... ,��� ............................... Chimney ........ ......... .1. ....... ...................... .. ....... provided that the person accepting this permit s in every respect conform to the terms of the application Final on file in 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI A T Rough Service ........................................................... ............... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. -- ® flee ® C®nsumer Affal axfln 10 Park Plaza e Suite 5170 Boston, Massachusetts 02116 Monte Improvement Contractor Registrati®n Registration: 162111 Type: Supplement Carat Expiration: 1/14/2017 NEXT STEP LIVING INC. ROGER OUELLETTE 21 ®RY®®CK AVE. 2TH FL BOSTON, MA 02210 Update Address and return card.Park reason for change. Address F-1 Renewal Fj Employment F� Lost Card CA' 0 50M-04,04-G101216 :'T ,j 161,cluaelir (office of Consumer!affairs&Business Regulation License or registration valid for individul use only ,HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation '{ Registration: 162111 Type: 10 park Plaza-Suit 5179 Expiration: 1/14/2017 Supplement Card Boston,MA 021164 NEXT STEP LIVING INC. ROGER OUELLETTE �C rel 21 DR`(DOCK AVE.2TH FL BOSTON,MA 02210undersecretary ' 03—'valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards Comtrsctioa &ipenisor Speciait% l icense CSSL-102811 ROGER A®`tel LLET 55 ST ORE 20 ` affWck RI 02 Expi ration Restricted To: CSSWC e Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation ofthis licensee For DPS Ucensing in ormagon v1sko www-Mass-GOO/01PS .' NEXTS=I OP ID:EL '�► R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY`t) 10_/0112014_ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O%y AND CONFER$ NO RIGHT4 UPON THIF CERTIFICpTP HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR A(TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REP PSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the gertificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIM,§90019 the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MGLaughli 1 su anco Agency -NiME: Erin Lyons ►1 f 0 y (AHiMN o Ext:781.665.2775 A No):781.665.02 828 Lynn fells Parkwpy EMAIL Melrose,MA 02176 John E.McLaughlin Jr. ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 INSURERA:Nautilus Insurance INSURED Next Step Wving,Inc. INSURER B:Commerce Insurance Company 3475 21 Drydock Avenue,2nd Floor IHsuRERc:A.I.M.Mutual Insurance Co. Boston,MA 02210 - tNSURERO AXIS Insurance Company 15610 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYR( INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC1li®� 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER MPMIDD EFF MMIDD EXP LIMITS A X, COMMERCIAL GENEW LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR ECP2010198-12 09130014 09/30/2015 PREMISES a occurrence) $ 190,00 MED EXP(Any one person) $ q 91900 PERSONAL&ADV INJURY S p GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ W,OQO,AQ POLICY 7 JEC LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABICO LITY MBINED SINGLE LIMIT $ 1�000,Op Ea accident ,. B ANY AUTO 14MMBGKKDM 09/30/2014 09/30/2015 BODILY INJURY(Per person) $ ALL AUTOS OWNED X AUTULED OSBODILY INJURY(Per accident) $ X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident S UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 D EXCESS LIAB CLAIMS-MADE El.U793547012014 09130/2014 09/30/2015 AGGREGATE $ 69009-09! DED RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER C ANFlCERIMEMBER EXCLUDED?ECUTIVE Y�N f A TO BE ISSUED BY CARRIER 09/3012014 08/3012015 E.L.EACH ACCIDENT $ 500,000 OF (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) FOR INFORMATION ONLY CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014191) Thp AQpftp rigrR#Wo 10,99,arq lc 4f ACORR The Commonwealth of Massuchusetts` Department of Industrial Accidents m Office of Investigations m a 1 Congress Street., Suite 100 t Boston,.AKA 02114-2017 wwwsmsc gov./dia WorkersCompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nalri@ (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston, MA 02210 Phone#:(866)867-8729 Are you an employer?Check the appropriate box: Type of project(required): 14 I am a employer with 850 4. ® I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. []New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have g• E]Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp.insurance.t g required.] 5. [] We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.E]Plumbing repairs or additions myself: [No workers' comp. right of exemption per MGL 12.®Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.®Other Insulation 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 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 state whether or not tho 3e entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: A,I.M Mutual Insurance Company Policy#or Self-ins. Lic.#:AWC-400-7030025-2014A Expiration Date: 9/30/15 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 required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage Y619dtion. Ido hereby certify under the pains and pen es perjury that the information provided above is trace and correct Signature: Date: Phone#: o)99- '83dtl 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#: next step livi ng TM Estimate pending resolution of Health or Safety Issues Next Step Living,Inc.("NSL") Kara Feraco 21 Drydock Avenue,2nd floor Boston,MA 02210 42 Church St#1 phone: (866)867-8729 North Andover, MA 01845 Site ID: A549717 27-Aug-14 1. DESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the customer's address above,in a professional manner and in accordance with the terms of this Contract,including the attached recommendationstwork order describing the work in detail(the"Work")which are incorporated herein by reference: Investment Description Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 2 Hr $150.00 Work Location: Wall Insulate Vinyl Sided Wall With 4"Dense Pack Cellulose 1,560 sgft $2,574.00 Work Location: Foundation Insulate Rim Joist with 6.25"Fiberglass Batting 154 Lnft $269.50 Initial Investment: $2,993.50 MA Save CMA Weatherization Incentive $2,150.00 Total Net Investment: $843.50 Estimated Annual Energy Savings from the Above Improvements $400.00 2. PAYMENT: CUSTOMER agrees to pay NSL for the work as follows: Payment#1: $100.00 -Credit Card or E-check deposit is due at the time the Work is scheduled. Required payment information will be collected over the phone by a customer service representative at the time of scheduling. Deposit is not to exceed 113 of the total retail costs. (Note:Mastercard,Visa,and Discover accepted) Additional Payments and Final Invoice: $743.50 Additional payments for the Work shall be due upon completion of the Work. If the final invoice is being paid by check,credit card information will still be required at the time of scheduling. Notify the customer service representative that you are paying by check and your card will not be charged unless we fail to receive payment within 5 days of invoice. 4✓-a 27 Aug 2014 Andrew Carpentier NSL Signature Date Name of NSL Representative The Terms of this Agreement are contained on both sides of this page Next Step Living^21 Drydock Avenue o 2nd floor.Boston,MA 02210.(866)867-8729^inquiry@nextsteplivinginc.com.www.nextstepliving.com TERMS OF AGREEMENT A549717 3.PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time,subject to the availability of subcontractors or materials,or to delays attributable to the weather or other events beyond NSL's control. 4.CONTRACTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to: Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116.617.973.6700. 5.PERMITS NSL will obtain any necessary permits as the Customer's agent Customers who secure their own permits or deal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6.PERFORMANCE OF THE WORK AND CHANGES 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer 6.2 This Agreement may be supplemented,amended,or modified only by the mutual agreement of the parties.No supplement,amendment,or modification of this Agreement shall be binding unless it is in writing and signed by all parties. 6.3 At times,our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents.Such concerns can include but are not limited to ventilation,potentially hazardous materials such as mold or asbestos,or structural concerns. In the case of health or safety concerns being identified, NSL reserves the right,per seclion 9.2 of this contract,to communicate concerns to the Customer and haft work until such concerns have been addressed. '6.4 The rebates and incentives available from the Mass Save®Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the NSL home energy advisor. However,at times our weatherization team discovers situations in the home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations,NSL will communicate such changes to the Customer,including any impact on amount the Customer would be expected to pay for the Work. The Customer will have the option to remove from the Contract the work elements that need adjustment,or set up a separate contract for performing the adjusted work. 6.5 NSL represents and warrants to the Customer that(a)the materials and equipment furnished under this Agreement will be of good quality and new,(b)that the work will be free from defects,and(c)that the Work will conform with the description of the Work described in Paragraph 1. 7.INSURANCE AND REGISTRATION NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration(No:162111)and the necessary insurance required by applicable law and normally maintained by prudent contractors in NSL's field,including,but not limited to,Workers Compensation Insurance for all employees who will perform the Work. 8.QUALITY OF WORK NSL agrees that the Work will be performed in a good and workmanlike manner,and that NSL will repair and replace,at its own expense,and promptly upon Customer's request,any defects in workmanship and materials provided by NSL which appear up to(1)year after completion of the Work or within any longer period as permitted or required under applicable law,provided NSL has received final payment as provided herein. 9.PRE-EXISTING CONDITIONS&PROPERTY PROTECTION 9.1 NSL shall rat be responsible for any damages as a consequence of the Work performed in the hone due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall,moisture damage,non-code construction,cracked or fragile siding or shingles,old pipes and fittings,rotting wood,etc. 9.2 NSL reserves the right not to perform Work upon the discovery of asbestos,mold,or any other potential health risk to the Customer. In this event,the Customer is responsible for remedying the at-dsk situation,including any necessary removal of hazardous materials and all bills for services to date shall be paid immediately. Work cannot resume until remediation is complete. 9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect,including dust protection,any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not properly protected prior to the commencement of the Work. 10.GENERAL PROVISIONS. 10.1 NSL reserves the right, the extent permitted by applicable law,to have,file or maintain a mechanic's or material men's lien,or to file a notice of intention to lien,and to take any other steps to perfect and enforce such a lien,If Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer.The parties represent and warrant that in executing this Agreement,they are not relying on any representations,warranties or terns other than as expressly contained herein. This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. You may cancel this Agreement if it has been signed at a place other than the NSUs normal place of business,provided you notify NSL in writing at its main office or branch office 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 form for an explanation of this right 11.ENERGY BENEFITS. The Sponsoring Utility Company(the Utility)is entitled to 100%of the energy benefits associated with all Energy Conservation Measures,excluding the value of energy cost savings by the Customer,but including all rights to all associated ISO-NE Energy,Capacity and Reserves Products.NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. 12.NOTICE CONCERNING SPONSORSHIP. Customer understands and acknowledges that NSL is not an agent,vendor or sub-vendor of The Sponsoring Utility Company(the Utility)with respect to the installation of an energy efficiency measures.In the event of the failure of an energy conservation device to perform as expected,Customer's sole recourse is to Contractor and not to RISE Engineering(RISE) or to the Utility.The Utility and its operating companies shall not maintain,remove or perform any work whatsoever on the energy conservation measures installed. Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. Customer agrees that it shall not hold RISE,the Utility,their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons Caused by the energy conservation measures. 13.LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 14.CONTRACT CANCELLATION Under Massachusetts law,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 a 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 Planview Diagram Customer lL Q 1-4 Advisor Name: n�i�o,�_� Address q Z h orc-,� Si. 26- I Advisor Phone #: Town _AI v--4-,ti An .,4,— Any limitations to access by truck? Site ID _ 14q -717 AO NOTES Any work scoped outside of Best Practices? Approved by: 2 k 0-3 A•/s - >ZJ O Wa !15 9r, DOL IS'GO ✓iA I - 6M000 Frame- 13'4- rL- G� '9+/ Y a 2 - 6 l✓64 3 l Z 3 3 l 3r� g z 3 �� 3 C z t 3 2