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Miscellaneous - 429 ABBOTT STREET 4/30/2018 (3)
/ 429 ABBOTT STREET T 210/038.0.0161-0000.0 J North Andover Board 6f Assessors Public Access Page 1 of 1 North Andover Board of Assessors E MO oTN Y • •'si •" Fs lProperty Record Card Click Sea]To Return Parcel ID:210/038.0-0161-0000.0 FY:201.3 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels Search for Sales Summary Residence r� Detached Structure E Condo 429 ABBOTT STREET Commercial Location: 429 ABBOTT STREET Owner Name: HERMANS,JOESPH T& SHIRLEY M, HERMANS REAL ESTATE TRUST Owner Address: 445 OCEAN BLVD#5 City: HAMPTON BEACH State: NH Zip: 03842 Neighborhood: 6-6 Land Area: 0.59 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2542 s ft _l ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 481,700 464,300 Building Value: 286,100 263,200 Land Value: 195,600 201,100 Market Land Value: 195,600 Chapter Land Value: LATEST SALE Sale Price: 1 Sale Date: 09/16/2002 Arms Length Sale A-NO-FAMILY Grantor: HERMANS,JOSEPH Code: Cert Doc: Book: 07088 Page: 0278 http://csc-ma.us/PROPAPP/display.do?linkld=2252307&town=NandoverPubAcc 3/18/2013 I Residential Property Record Card PARCEL ID:210/038.0-0161-0000.0 MAP:038.0 BLOCK:0161 LOT:0000.o PARCEL ADDRESSA29 ABBOTT STREET FY:2013 PARCEL INFORMATION ZZ�R 101 Owner: T Sale Pnce 1 Book. 07088 Road T e: TSale Date 09/16/02 Page: 0278 yp Inspect Date: 09/28/2011 HERMANS,JOESPH T&SHIRLEY M, 2542_''_SaleType:"P " "' - P HERMANS REAL ESTATE TRUST Cert/Doc: Meas Date 09/28/2011d Condition:.59°" Traffic: "M """Entrance: X Sale Valid: Address: Water."445 OCEAN BLVD#5 Grantor: HERMANS;JOSEPH �� �� .. - r CollectId RRCSewer: nspectReas: " CHAMPTON BEACH NH 03842 0 -_- Resid-B/L/a 100/100 Comm-13/11/0 Indust-B/L- /,,/,, / Open Sp-B/L% / RESIDENCE INFORMATION Style: CL Tot Rooms: 8' Main Fn Area: 1516 Attic: LAND INFORMATION Story Height 2.00 Bedrooms 4 p NBHD CODE:6 E: R3 Roof U F_n Area 1026 Bsmt Area: 1.324 Seg T'' e` G Full Baths 2 - Add Fn Area: '"` yP 0 de S ethod S Ft "'W&6 s. D CLASS: 6 ZONE: Ext Wall: F6 Half Baths M 1 AddUnfiArea Fri Bsmt Area: " 1 P _ q` Influ-Y/N _95 56 Masonry Trim Ext Bath Fix: 0` Tot Fin Area 2542 BsmtGrade 25829 0.590 ° -- Class Foundation: CN Bath Otaal. T VALUATION INFORMATION 9 RCNLD: 286132 _ Current Total: 481,700 Bldg: 286,100 Land: 195,600 MktLnd: 195,600 { Krtch Qual S" Eff Yr Built 1992 Mkt Adj:` Prior Total: 464,300 Bldg: 263,200 Land: 201,100 MktLnd: 201,100 Heat Type. HW Ext Kitch: Year Built 7984 Sound Value: I Fuel Type O - —. �:� Grade: ' G` Cost Bldg °"__286,100" Fireplace 1 BSmt Gar Cap:2 Condition GV Aft Sir Vail-' u` Central AC N Bsmt Gar SF. m' Pct Complete: ` "qtt Str Val2.s Aft Gar SF. %Good P/F/E/R" 7100/100190 l Porch Type { W 60 r h Area Porch Grade Factor SKETCH I PHOTO FM +t \ 12 192 S%Ft 12 c 5 60 Rte' { I FM/B FU/FMJB 336 S Ft ' -- q• 988 Sq.R 24 � � x 26 IMP 38 Sq.Ft X129 �B�OTf STREET Parcel ID:210/038.D-0161-0000.0 as of 3/18/13 Page 1 of 1 ---- ------- --- Location No. Date g' R- 1,3 • - TOWN OF NORTH ANDOVER Certificate of Occupancy , $ .r Building/Frame Permit Fee Foundation Permit Fee $ r,� �u° Other Permit Fee $ kv TOTAL $ w Check#�L� f f Building Inspector TOWN OF NORTH ANDOVER ,APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued:k-1 r IMPORTANT: Applicant must complete all items on this page LOCATION ,�� Print / PROPERTY OWNER� /1C� Print 100 Year Old Structure yes MAP NO: -37q PARCEL:Ab.1 ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne 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 El Water/Sewer DE CRI TION OF WORK TO BE, ERFORMED: Identificationse Type or Print Clearly) 47 —11 OWNER: Name: Phone: Address: / CONTRACTOR Name✓ Phonex/ �� v�✓s'��q Address: Supervisor's Construction License: �"� Exp. Date: Home Improvement License: Z-;7 l —Exp. Date: ARCHITECT/ENGINEE �� � 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: $ FEE: $ z�C-) r— - Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the r-a fu 6 Signature of AgentlOvvner Sig nature of contract Plans Submitted 11 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 11 Building Department The fol swing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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 o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report Li 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 apo,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submJted with the building application Doc: Doc.Bui�ding Permit Revised 2012 i Plans Submitted❑ Plans Waived❑ TYpE Dr SRW13RAGB n1SP.0SAL _ Certified Plot Plan ❑ I� public Sewer Stamped Plan, ❑ ' Well ❑ T "g/Massage/BodyA Private(se Tobacco Swimming pools Phc tank,etc. � Sales ❑ permanent Du m 0 rood Packaging/S pster on site ales ❑ THE FOLLOWING INTERDEp f�F2TMEHT�1®HS FOS OFFIC 1 L SIGN�FF E USE ONLYU FORMPLAf�IallillG ®EVELOPM DATE REJECED . EP�T ❑ DATE APPROVED COMMENTS ❑ CONSERVATION Reviewed on COMMENTS Si nature HEALTH Reviewed on COMMENTS Si nature Zoning Board OfgPpeais:Variance, Petition No: � Planning BoardDeciZOn ng Decision/recei sion: pt submitted yeS Comments *Conservation Decision; f I 'Water&Sewer C Comments i onnection/5i nature&Date ' O'" 1�n ganeer' S-gaatupe: Drivewa FIREOEP Permit ARTLr'�1 Located at Mair.,Sfreet Temp Durnpster o Located 384 Fire Departrnepit si n site yes os ood gnature/date Street r no COMMENTS I -- -- -------- DOC.B{( t i Doc: Doc.Buiiding Permit Revisea-/,)r� J I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPEOF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/13ody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ - � I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i } Planning Board Decision: Comments r ,,Conservation Decision: Comments fE� •Water & Sewer Connection/Signature Date Driveway Permit I a DPW Tow; Engineer: Signature: � Located 384 Osgood Street FIRE-DEPARTMENT Temp Dumpster on site yes no I Located at 124 Mair,. Street Fire Department signature/date COMMENTS_ NORTH Town of t 1, Andover to No. h ver, Mass, • ' COCHICH/WIC. �,9 p�RwTEO r,PP��S S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System / L THIS CERTIFIES THAT ,, ,,�, BUILDING INSPECTOR .................... ......... .. ........... ..�..................................... has permission to erect buildings on 4 —1........����. Foundation .......................... ... . .... ....... .. ................ 6 Rough LV . le 19to be occupied as ....... ........ ..........X.►. -..! "..�?'/!!�. ... ........! ... ..1� Chimney provided that the person accepting this permit shall in every respect conform tc the tdrms 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 rp PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ....A T Rough Service .................. .............. .............. Fina 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. SEE REVERSE SIDE Blyth Builders Inc. PO Box 992 Hampton NH,03843 Ph 603 929 0898 CSL#38567 HIC#171034 Where as Blyth Builders(herein referred to as the Contractor),agrees to perform the following work for terry and Corinne Hermans 429 Abbott St, North Andover The Contractor is a New Hampshire Corporation.The Contractor has the full ower and authority to P p p Y enter and perform its obligations under this contract.This contractor is fully licensed in the State of New Hampshire and the Commenwealth Of Mass achusetts as is required for the work and shall maintain and keep all such licenses in effect for the duration of this contract.Stephen M Blyth is the President of the Corporation and is fully authorized to execute and deliver this Contract on behalf of the Contractor. The Contractor shall be responsible for any and all construction related permit applications with regard to the Work,acting as owners agent.These permits include building,electrical, and plumbing.. Further, Contractor agrees to meet with local,and State officials regarding the same. If the Contractor fails to perform this Contract as required,Owner shall have the right, upon three days notice to Contractor to terminate the Contract and take possession of all materials on site and finish the Work as Owner may determine. The start time will be 1uly3rd(pending permit)and substantially completed by August 15t. 2013 Warranty-Contractor warrants to Owner that all materials and equipment furnished shall meet the requirements of theNorth Andover Building Inspector Inspector and State and local codes.Contractor will give a one year warranty and materials The Work shall consist of the following: -We will remove the center petition from the stairwell end to the end of the kitchen wall -we will install a beam in its place -remove all of the flooring in the kitchen,dining room,and front hall -install new the throughout the area. ($4.00/s.f.to purchase, contractor to install) -install new front door supplied by owner -install island,along with electric outlets. Island supplied by owner -we will keep the short wall next to the front hall closet -we will patch and paint the ceiling where the wall creating the hall in the foyer is removed Price $12,500.00 Payment schedule: Deposit $2,500.00 Commencement Of work $2,500.00 Beam complete $2,500.00 Tile complete $2,500.00 Completion $2,500.00 The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action tas an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitrat' firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Rcgulati n and the consumer shall be r wired to submit to ch a r ' as provided In Massachusetts General Laws,chapter J. Homeowner' a e Conti ctor's ature NOTICE: he s atures of the parties above apply only to the agreement of the parties to alternative dispute resolution' 'tia d by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may he excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems hinVberself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http•//www.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at httw//www.mas;s.Rov/oca Go online to view the status of a Home Improvement Contractor's Registration: http7//db.state.iiia.us/homeiniprovement/iicenseeljg.as 2 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1•11122/2010 L NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business]NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TR ISS I Date: Buyer's Signature: A� 07/15/2 CERTIFICATE OF LIABILITY INSURANCE DD/YYYY) 07/15/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S).AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION is WAIVED,subject to 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 NAME: AUTOMATIC DATA PROCESSING INSURANCE AGCY INC AICNNo Ext: 977 677-0429 FAX No): 977 677-0430 1 ADP BLVD MS 325 E-MAIL ROSELAND,NJ 07068 ADDRESS:s hicae elers.com (877)677-0428 PRODUCER rtuff..ER'D it, 6305T6165 XV770 70A INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER ATHE PHOENIX INSURANCE COMPANY BLYTH BUILDERS INC INSURER B: 34 BARBOUR ROAD INSURER C: HAMPTON,NH 03842 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 697348114580691 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADDL SUBR POLICY EFF POLICY EXP TR TYPE OF INSURANCE INSR WVp POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LUIBIITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY O CLAIMS-MADE r—]OCCUR PREMISES(Eoccurrence) $ MED EXP(Any oneperson) $ PERSONAL$ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ PRO- POLICY OJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS E HIREDAUTOS (Par accident) GE $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ CC $ A WORKERS COMPENSATION N/A UB-1C479836-13 07/25/2013 07125/2014 X TORY LIMITS OER AND EMPLOYERS'LIABILITY YM ANY PROPRIETOR/PARTNERIEXECUTIVE❑ E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,desrnbe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION THE TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MASSACHUSETTS EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE 1600 OSGOOD STREET WITH THE POLICY PROVISIONS. BUILDING 20,STE 2035 NORTH ANDOVER,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts- Department of Public Safet% . Board of Building- Re-ulatiiins and Standards Construction Supervisor License License: CS 36.567 r STEPHEN M BLYTH ti 34 BARBOUR RD HAMPTON, NH 03842 Expiration: 9/14/2013 0muni--mer Tr#: 1878 f °nye actBifsincss ega a on Otfiee`ot a fr..er airs HOME IMPROVEMENT CONTRACTOR Type: - Registration: _;171034 c Expiration: .7l1jZU14 Individual KENNETH BLYTM; KENNETH BLYTIH=, 9 WEST SHORE DR._ SANDOWN,NH 03873y,. - Undersecretary w., 15'/'iC�.E bF I�EI�HAM�SI�tRE 'wy - j':gEgylCfS 5 � [SEPT_OF ENVIRONMENTR _ 1111`TER pIVISION STn mere ps Whenebyautho77e to Install sewage �; dis�sal systems Put'sti`entto FSA 485-A. ... •-.""Expires December 31;.2014�M;, , ' III Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions- Total imensions_Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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 - Date f ' Doc.Building Permit Revised 2010 I � i i Building Department I r The folowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofif-g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract D 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) +' o Copy of Contract Li Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products (COTE: 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 apo.-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:?ted with the building application Doc: Dac.Bui!ding Permit Revised2 I �� 4 Date $�w,tt up rim TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .o.(.�: -' - . . . . . . . . . . . . has permission for gas Inst llation . in the buildings of `\I\C, . . . . . . . . . . . . . . . . . . . . . . at . . . . Z. .I. .T .1 . . '. . . . . . . orth ndover, Mass. FeerLic.No.��_ . y!!� '�./• . . �. . GASINSPECTOR Check#-do MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK UCITY AP; Math h �oVCr MA DATE f� � PERMIT# JOBSITE ADDRESS Zla� OWNER'S NAME�jI'//'I/9� l�/'l�1Cpl� S GOWNER ADDRESS TEL�jj�L�37N'Z:�pO FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:: RENOVATION: REPLACEMENT PLANS SUBMITTED: YES: NO APPLIANCES Z FLOORS BSM t 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 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 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND 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. C SIGNATURE OF OWNER OR AGENT HECK ONE ONLY: OWNER 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 Pertin nt ro i 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME. MICHAEL H HOUSE LICENSE# 7173 S N T R MP - MGF JP JGF LPGI CORPORATION # 3377 C PARTNERSHIP # LLC # COMPANY NAME: MERRIMACK VALLEY CORPORATION ADDRESS 15 AEGEAN DRIVE,UNIT#3 CITY METHUEN STATE MA ZIP 01844 TEL 978-689-0224 FAX 978-689-2206 CELL 978-884-3427 EMAIL Ilittle@mvalleycorp.com or srutter@mvalleycorp.com I v N 9667 Date. 7' TOWN OF NORTH ANDOVER 00 0 PERMIT FOR PLUMBING �sS^cmusE� 4- This certifies that . 41.4 (� �!pi+ . . . .�. .. . . . has permission to perform plumbing in the buildings of` . . . . . . . . . . . . . . . . . . at. .42-9. .� � .. . . . . . , North Andover, Mass. Fe;67Uu . .Lic. No.j.�J�. . Mb. . . . . . . . . . . . PLUMBING IN Check # i�l�� WHITE: Applicant CANARY: Building Dept. PINK:Treasurer j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY,' - _ - ., ���_']_. ._..._._' C-� ' MA DATE��C���_ (PERMIT# JOBSITEADDRESS � i� --� -3 OWNER'S NAMEj�.� OOWNER ADDRESS � 3 'C (rqX r,'- TYPE OR OCCUPANCY TYPE COMMERCIAL 1__7 EDUCATIONAL ( i RESIDENTIAL PRINT CLEARLY NEW:(_.. RENOVATION:( REPLACEMENT: PLANS SUBMITTED: YES(„ , NO FIXTURES-1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM - 1-` -_. _ _ w._ i' _..._. _•, DEDICATED GAS/OIL/SAND SYSTEM 1, i; ; I; ; DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM l i_.__ . ._ .... L. . _ ......__.._...------ .......__ , DISHWASHER - - - --- DRINKING FOUNTAIN + i FOOD DISPOSER ----------- _.._.. FLOOR l AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK -- —_�_ --_ -----..-i LAVATORY ROOF DRAIN SHOWER STALL _ -- i SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION ! — m -- -- -- — - - --- WATER HEATER ALL TYPES ! r WATER PIPING_.._ _ -- F OTHER --- - -- �ax� .� - , INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES(�i NO [! IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY I` BOND f 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. CHECK ONE ONLY: OWNER AGENT L 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I MICHAEL HOUSE - _�- t LICENSE# 7173 SIGNA I U E MP' JP[ CORPORATION; #�3377 C -'PARTNERSHIP[_,_#`- LLC !# -- _ COMPANY NAME MERRIMACK VALLEY CORPORATION ADDRESS[L5 AEGEAN DRIVE,UNIT#3 CITY;METHUEN I STATE;-I MA ZIP ;01844 TEL 1 ��----- -- 978-689-0224 ' FAX 978-689-2206 'CELL 1978-815-4523 i EMAIL i LLITTLE@MVALLEYCORP.COM ` The Commonwealth of Massachusetts Department of InduMid Accidents Office of Investigations 600 Washington Street Boston,Mass 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: ��`"/ 09cl ,�� - '?J City/State/Zip:_ vjd Phone#: Are ou an employer?Check the propriate boa: project(required • 1 XI am an employer with- ,moo^ 4.O I am a general contractor and I fie of ro eat ) employees(Evil and/or 6. ❑New construction �Vie)'* have hired the sub-contractors 2. 0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have workingfor me in an S. ��Demolition [No workers'comp.insurance employees and have workers' 9. 0 Building addition Pcomp.insurance.$ g required] 5.0 We are a co 10. 0 Electrical 3. !] I am a homeowner doingall work a exercised and its repairsor additions myself officers have exerrcised their �o workers'Comp• right of exemption perm MGL 11.0 Plumbing repairs or additions insurance required]t c.152,§ 1(4),and we have no 12.0 Roof employees.[no workers' s� comp.insurance required.] 13.(x(Other //�L� i �jrc1 'Any applicant that chocks boz#1 mast also fin out the section below sh , /`�tl��Ov � f��•l/!1/ �� tHomeowners who submit this amdavit indica' th �g their workers compensation policy information. tmg ey are doing an work and then hire outside contractors must submit a new affidavit indicating such. *Contactors that aback this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entitles have the sub-contractors have Io they must provide their workers'eo employees. u I am an employer that is pr number. informahion. °fig workers'compensation insurance for my employees.Below is the policy andjob site Insurance Company Name: Policy#or Self-ins.Lic.#: j Expiration Date: /3 Job Site Address: City/State/Zip: .cls' tJ'�,,���/�y J Attach a copy of the workers'compensation policy declarationpage(showing thepo icy number and expiration(date). Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal up to$1,500.00 and/or one year imprisonment as well as civil Penalties fine fine $250.00 a da penalties in the form of a STOP WORK ORDER and a fine of y against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for cove verification. I do herby a fy un ?the ^airs a aNes�ofp r� ry th the o e l •. Provided above is true and correct Si nature Print Name: Phone#: �j U official use only Do not write in this area to be completed by etty or town official City or Town: Permit/license#• Issuing Authority(circle one): I-Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspect 6.Other or Contact person: Phone#: i U O N .�, •���;:;}ici;l',�icj;l }3)��1i'i:`i�•ia�i+!'U�ijiir. �::i,•iV:�j��:.:��-,^i i PLUM QRS AND odsF1T7Rgg , PCENS ,D AS A MASTER PLUMBOR - 1" I sU1SS 99iE ARCM:u ramp i'Cr ! m X -HA ' .H HRUSE fs"63 M-RoARSH. LN 9BEE,MEE 'CWP MR o4G14 6137;.., `` . :71.73 05/01/14 1k674A �; ., �..ib�s'� ".�,t'IYi� ;�:jij�,,' ..�.i:�if�':,��If�i"�• ��j 1 7 0 m Y_ Q f\ N N O N r cu O t Date. 1,j�/�Z. . 9436 "oRT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,ISA CMUSE` rot .P - This certifies that . . . 1 has permission to perform . . . . C/x?hlS.�l� r. plumbing in the bui ing of . . . Crlrl�'�S' /Z9. .�. . .a . at . . . . . /. . North Ando er,,ivJass. Fee. ZO.Lic. No.. PLUMBING INSPECTOR Check k 1/030 a X ti Q�11 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY -- MA DATE 11"_r .�/�( PERMIT# JOBSITE ADDRESS 1 4 2_Q OWNER'S NAME nm erne P OWNER ADDRESS TEL[ Q�FAX[::�= TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NOFP FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE _ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM �_._._. I ~ _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM li DEDICATED WATER RECYCLE SYSTEM DISHWASHER �7 _ DRINKING FOUNTAIN _y FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY r-- r— ROOF DRAIN SHOWER STALL -T- f SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER - _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES W, 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 ar aaware 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. CHECK ONE ONLY: OWNER ❑ 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 t best of m knowledge and that all plumbing work and installations performed under the permit issued for this applicatio Ir wi It�e it comp'ance with II P i t on the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMCL:jkbC� LICENSE# NATUR MP EJ J CORPORATION❑# PARTNERSHIP❑# C❑#[�!�❑ COMPANY NAME J ADDRESS v-%D,baa -ek CITY STATE[S�a] ZIP TEL FAX CELL��EMAIL ` . The Commonwealth of Massachusetts Print Form .m Department of Industrial Accidents x Ogee of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name(Business/Organization/Individuai):w 2�k)rnbjYQ, Address:—I a I City/State/Zip: �L Phone M Are you an employer?Check the appropriate box: Type of project(required): 1111 am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.V I am a sole proprietor or partner- listed on the attached sheet. ?. ❑Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.# 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.❑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' 1311 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 are doing all work and then hire outsidecontraetors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. Insurance Company Name:_ Policy#or Self-ins.Lic.#:__ _ ______._ _.___ Expiration Date: Job Site Address: "eq AbA(S-/— City/State/Zip:.D..�� U t Uel a Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb tert&under the a' and nahMes ofperjury that the i ormadon provided above is true and correct. Si ° Dat Phone#• Official use only. Do not write in this area,to be completed by city or town o ic&aL City or Town: Permit(License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: