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Miscellaneous - 5 BACON AVENUE 4/30/2018
5 BACON AVENUE I -- _. - - 210/045.G-0057-0000.0 ----- - ------- J I r t 1 �� �d:YM1..{ d�-;•yl*N}f34::.�4-'k+ .. r ; .. .1 t ..a �.1.. `` Location �1,..� No. " y� Date / r� ` o - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� lY .Foundation Permit Fee $ ������; Other Permit Fee ixEi� $ { TOTAL $ Jr�r�n`FE' a Check 266-/ 57 Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received lz� Date Issued MP RTANT: Applicant must complete all items on this page LOCATION__ Print=, PROPERTY OWNERTS �_ - -- Print 100 Year Old Structure yes no. MAP NO: �) _PARCEL: _7 ZONING DISTRICT _. -'Historic District yes no, - Machine Shop Villa `e, es, no p _ g _ _ y_._ ___, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential p ❑ New Building XOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 9 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic El 1Nell El Floodplain ❑Wetlands ❑ Watershed District Water/Sewer n DESCRIPTION OF WORK TO BE PERFORMED: PtC ,oraz Z i 1"ly t r7�LC S'rj-r a 1tC-' C +'Ceavv Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: , - f-Inl w �'.�� - = Phone: J r�' �S"7- .6.617 v7 _ Address: ZS'"tf"� M411 Supervisor's Construction'License: �� ` _ Exp. Date: Home Improvement License; _ 1 b 1 m_- Exp._ Date: 7-110- ZDI 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: $ 0 FEE: $ �/ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty fund i Signature.ofAgent/Owner Sig afure,of contractor 94 1;4j I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 0 Stamped Plans ❑ i I 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ERAGE TYPE:OF.SEW :DISP.OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales I❑ t` Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments k Conservation Decision: Comments Nater& Sewer Connection/Signature& Date Driveway Permit DPW To`vo Engineer: Signature: Located 384 Osgood Street FIRE DIEPARTME`NT Temp Dumpster on site yes_. no Located at 124 Mair, Street Fire Depar-tmert,signature/date" 3 -� . - , r, • , COMMENTS Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 359000.00 m $ - $ 420.00 Plumbing Fee $ 52.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 52.50 Total fees collected $ 625.00 5 Bacon Avenue 082-14 on 7/24/13 2 Bath remodels, Kitchen remodel I JOHNP-2 OP ID: HG DATE MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/23/2013 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(ies) 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). CONTACT PRODUCER Phone:617-847-0005 NAME: Commonwealth Ins.Partners LLC Fax:617-847-0006 PHONE FAX 25 Newport Ave.Ext. A/c No Ext): AIC, IC No): N.Quincy,MA 02171 E-MAADDRESS: Commonwealth Insurance INSURERS AFFORDING COVERAGE NAIC# INSURER A:Hartford Insurance Company INSURED John Paul Construction , Inc. INSURER B:TRAVELERS INS.SERVICE CENTER 2543 Main Street Tewksbury, MA 01876 INSURERC: INSURER D: 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 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. INSR ADDLTYPE OF INSURANCE INSR V POLICY NUMBER MM/DD/YYYY MLICY EFF M LICY EXP LTR /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY 680608SN563 06/08/2013 06/08/2014 PREMDAMAGE T REN 300,000 PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 X Business Owners PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Pera ccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEO I R t $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY T rR IMI A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/❑N NIA 08WECRJ2232 01/25/2013 01/25/2014 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) This certificate is hereby issued as evidence of existing insurance coverage. CERTIFICATE HOLDER CANCELLATION TOWNNO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street N.Andover, MA 01845 AUTHORIZED REPRESENTATIVE Commonwealth Insurance ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 07/23 113 13:30 b1 tU41UVJb UUMMUNIAILAL I M IN:D rMvr- uAi UL r JOHNP-T OP im HIS v��s IMMIDD,'m'n ,4E�o CERTIFICATE OF LIABILITY INSURANCE o7l2anola THIS 6 IAT! 10 ISSUED AS A MATTER OF INFORMATION ONLY AMC) CONFERS NO RIGHTS UPON T11E CERTIMICATE HOLDER.THIS Cl!"FICAT 10099 NOT AFr1RMUTmLY OR NEOAT1vELY AMINO, LVMNO OR ALTER THE COVERAOe AFrOROID 6Y THE POLICIES SOLOW. T CERTIFICATIE OF INSURANCE 0006 NOT CONSTITUTE 4 CONTRACT SQTweEN THE 1SSUIN0 INSURER($), AUTHORIZED R irptESEN TWE OR PRODUCER,AND THE CIRTIPICATR MOLDER. IMPORTANT 11 tlllr us.tHioste elder b an ADDITIONAL INS IR�D, tree WiGAIss)must endorsed If dUBROOATION 19 WAIVED,subs to the terms sn condltlons of the policy,o"In pollutes MSY reculm Sn endongmenL A datsmsnt on this CerdAoate dws not confer rights to the aertlfloate hdftr In 11su of h endor6mon s. PRooucil Phone:617447-000 GOMM Ins.P*Mwry LLC Pax.017.4474004 :�A11a 26 NawpoIt Pict. N.Qulncr,MA ,Insulenos Dommanwssl Rs1r s Am Rar"o c .,� •Hartford Insurance Company INwII1fo J n Paul ConIlifte Ion ,Inc. siva .:TRAVELI:Ra INS.SERVICE CENTER 2 Main street weu c T kabury,MA 0107E 11401111121%12 _ I RACERTIFICATE NUMBER. BEVMfiE " 1Ti Id TTOR THAT Tyle POLICIES OF INSURAN61<LISTED BELOW NAVE BEEN 1@81JED TO THE INSURED mmeo ABOVE FOR THE POLICY PERIOD INDICATTHSTANDINO ANY RICUIfIGMFNT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMINT WITH rilrSPECT TO WFSCH THIS CERTIFIE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED eY THE POLIGIRS DCSCRISMg HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUSONDITION8 OF SUCH POLICIES,LIMITS SHOWN MAY HAVt:BEEN RMIUCED UY PAID CLAIMS uesTs 06 rim r/evRANCs 000,0 e,►oN oc ul+r,eNae E 1, GeRCIIIIALL Ofuly 300,08 O X COWA CIALUNGRALLIASILIfl' I lOe6Nt14D 0610012013 061001$011 S Moo w1P: m.Pnrrael' ! see C mi-MADIII 21 OCCVA 01SWI41AL A ADV INJURY a 11,000.004 7( IEu61 se OKngrs 2,000,0 - ®LNefVU. OAT70 i PWOp CTS-COMPW A®0 'i 2000.00 ueNt A04 ame UIHR APPLIES OM a POL ' LOC 1IINGLELIMIT AIJTOM LIAMJry ! EODl.v nuuRY(►w PQM ANY 0 BODILY INJURY(PW Mdd@rVO ! A ?QDULl--O — VNJ,IAM80 ! NOR AUTO$ I GACH OOOURRCE U4 WAG OCCUR A1! ! WON uAe p1A,Mi.MAn! ! mmm ON BANyI fX00, AND IM YQRrr y�AelLlT`, ONWECRJ2232 all= 2013 01125117014 G.1,,VCH ACCIDI Nr i AA%icq eTpRrPAA1Na•+exsCUTIve N,A !.L DlpeaE! EMPLAYIG s 100,00 M. 1R_sx.Luaepv l�] 600 a (PRIG Nl Y L DOOOMPTId1 �pAeaATN1N11 f LOOArIDNe!VeNICLle(AY1d1 Aeon ICI.AWtwd Rams saMWl'.N"mm"01s ngd►W) This Q=t fieALts in hereby issued as evidanOw of existing insusstivs covers". M TOVIINN02 SHOULD ANY OF TMa AAM 966CAIBLD POLICIES ai CANCtLL.I_o"pope THE EXPIRATION DAT, TMaRl�lOF, NOTIae WILL s/ DFLl MI5 IN own of Nortll And"r AC001kOANCR MTH To POLICY PIRMNIONS. 1500 Osgood Street N.Andover.MA 01446 Au>rrrollslge ASPw�ssNrAmi Commomw&4""ursnce m 19se4010 ACORO CORPORATION. All rights reserved. ACGRD 2 4010106) The ACORD name and Iago erg registered InoI+u of ACORO TO 39vd 30NvNnSNI0NViHVd 998LT89T8L 9T:0T ETK/b7,/L0 NORTy own of 2 EAndover O . - to No. _ * t - - �� h , ver, Mass, 2� 2 3 COCNIC.IWICK S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .. 4.��. 7ri P4PA.�.. .. ..... �!!............ BUILDING INSPECTOR ....... ........ . .................................. has permission to erect buildings on ..... �.�,�...&cf.* ............... Foundation .......................... ....� Rough to be occupied as ..... ..1...�i� ��w�................................................... Chimney provided that the person accepting this permit shall 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 EXPIRE17TH ELECTRICAL INSPECTOR UNLESS CONSTRS Rough Service .... .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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 The Commonwealth of Massachusetts Department of Industrucl Accidents Office of Investigations qu 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors(Electricians/Pluimbers Applicant Information Please Print Legibly Name,(Business/Organizationgndividual): &4 eon+S7—X lfCn, p� Address:_ ZSY 3 mA- ro - City/State/Zip: f / Mff 0187 Phone I S-7--ZOO - Are you an employer?Check the appropriate bog: Type.of project(required): L KI am a em to er with / 4. ❑ I am a general contractor and I P Y 6. ❑New oonstruction employees(full and/or part-time).* have Hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.z 7. E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. Building addition [No workers'comp.insurance 5. El We are a corporation and its 10.E]Electrical repairs or additions required.) officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' comp.insurance required.] 1313F]Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they a're 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. - !1;AVar7,R74. _-Z_A/.f 49W!eC Policy 4 or Self-ins.Lie.#: ExpirationDate: Job Site Address: spX-0,J V City/State/Zip: M, Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL 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 sof Investigations of the DIA.for insurance coverage verification. Ido hereby cert r the dpen ies ofperjury that the information provided above is true and correct. Signature: p Date: / Phone#: 97F D/S x'90 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and bstructions . 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 ofthe foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be,returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials -Please be sure that-the affidavit is-comp lete-and printed legibly. The Depzt ent has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho CommollweaIth ofWassarliv.e is Departweiit offadustdal.Accxdeats Office of Inyestigatitou 6.00 V1 mhh gtoxi Street Boston,UA,02111 TQJ,#617-72,7-4900 0A 406 or 1-877-WRAFB Revised 5-26-05 Fax#617-727-7749 Unum Mpeo rrnzrtA,. ` �dlas>achusctt - Department Ot* public safctN Bo.u' Buil(lin-, Re-ulati011s and �tanil.u'ds Construction Supervisor License License: CS 54969 JOHN F BERUBE j 2543 MAIN STREET TEWKSBURY, MA 01876 Expiration: 11/27/2013 -T r#: 7062 \3 )office of Consumer Affairs&Busifiess Reg l ..''Me IMPROVEMENT CONTRACTOR.; ' eg Aration: 64989 Private Como, xpiration 7l 01d JOHN=P'AUL CONS+f ��t a j } John Berube y, k 2543 MAIN ST. f •TEWKSBURY,MA 01876 Und'ersecr. ry ' _l CONTRACT PROPOSAL Page 1 of 4 =o= Date: July 10, 2013 We herewith submit proposal for materials and labor to be supplied at the sole request and order of: Name: Home Phone: Job Address: I` Ms Judie Tenenbaum 5 Bacon Street HN-PAUL Address: Office Phone: North Andover, MA 20 Upton Avenue CNSTRUCTION Providence, RI 02906 other: Jon Name: Tenenbaum Hereinafter referred to as owner,to be performed at premises set forth above,according ti the following terms and specifications: Contract Proposalto : •• r• Supply materials and labor to install kitchen and two baths as discussed. Contractor is responsible for plans,permit and necessary inspections. If needed,owner is responsible for a Plot Plan and any additional information/engineering as required by the building department. Clean, prep and paint fiberglass shower and tub/shower units in baths,white is recommended. Nail off existing plywood floor sheathing in kitchen and both baths with 8d ring nails.This is done in an attempt to minimize/if not eliminate any"squeaky floors". Supply and install 3/8"plywood to kitchen and (upstairs)full bath floor,scrape and prep concrete slab in basement bath prior to the installation of ceramic/porcelain tile.Tile for basement bath, hall and utility room is "Anatolia" 13"x13"Portofino Beige.Tile for 1 st floor (master bath-up) is "Anatolia" 12"x12" Classic Carrara. Tile for the kitchen floor is "Anatolia" 13"x13" Prato Ivory and backsplash tile is"Anatolia" 3"x6" Prato Ivory. Supply and install one 36"JSI Dover style white vanity in 1st floor(master bath). r' Supply and install "JSI-Salem"cabinets with cherry stain-standard overlay shaker style door with slab draw fronts. Cabinets are all wood construction and have standard wood draw boxes with side mount drawer runners. Supply and install "Santa Cecilia Light"granite top with single bowl stainless steel undermount sink in kitchen. Granite will be finished with a standard "bull nose"edge. You,the buyer,may cancel this transaction at any gime prgor to midnight of the third business day after the date of this transaction.See the attached Notice of Cancellation form for an explanation of this right. All materials are guaranteed to be as specified and to carry manufacturer's warranty.All work to be completed in a neat and workmanlike manner.Any • alteration or deviation from above specifications involving extra labor and/or materials costs will be executed only upon written order from the owner or hi: her authorized agent and will become an extra charge over the below agreed amount.Agreements made with mechanics or subcontractors on the job are n recoginized.No statement,arrangement or understanding,expressed or implied not contained herein will be recognized. We propose to furnish and install the above complete in accordance with the above specifications for the sum of: Thirty-Four Thousand Eight Hundred and Eighty-Four and 00/100 Dollars($34,884.00)Payment to be made as follows Balance of payments to be made as follows: See payment schedule page 2 + Total Amount $ 34,884.00 Customer must cooperate with JOHN-PAUL CONSTRUCTION,INC. Deposit $ 5,000.00 the fullest for performance of payments and work procedures with the regE r' to said job.Any delays on the customer's part will slow procedures of the j Balance $ 29,884.00 and constitute delays on the part of JOHN�AUL CONSTRUCTION,IN due to the resulting change in our schedule. Contractor's Acceptance Owner's Acceptance Work to be started on or before j(Il 1- G `U I The foregoing terms, specifications and conditions are satisfactory and ar( t 12 W-) hereby agreed to.You are authorized to do the work as specified and paymen and be substantially completed on or vtbnefore A� will be made as outlined above.The owner upon signing this agreement repre . Company Representative �' `� .ic.# Bents and warrants that he/she is the owner of the aforesaid premises and the ,t Accepted by Contractor Lic.# 5-11f,64 he has read this agreement. — — v Owner: Date: This proposal may be withdrawn if not accepted within 3 days ` • Owner: Date: x ' t 2543 Main Street Tewksbury, MA 01676 , . 976.657.6007 CONTRACT RRORO_ SAL°' ® t Page,2 of 4 , Y + Supply and install two white "Kohler" comfort height toilets with seats:`Supply and install one "Kohler" kitchen faucet and two "Kohler"lavatory fau`cets:,Suppiy and'install a one; piece sink top.on 1 st floor(m aster Vanity.'Supply and instaILone white pedestal sink in down stairs (basement) bath. Supply and install two bath.extiaust fans vented,outslde=as per�code ` Supply and install'new electrical devices (plugs andAsvkches) as per code'requirements:';,4 All devices will be white devices standard specification (toggle/residentiai grade). Fixtures (including bulbs) will be supplied by owner and installed by electrician .Supply and install necessary wiring and.detector devises.(upgrade exlstin'g,smoke detec- for system) as per code requirements:This includes'battery back.-up hard wired smoke/ heat and carbon monoxide detectors on'both floors of house and,2.heat detectors in the garage. t t Clean up and disposal of construction debris resulting from abovedescribedwork in trailer 'located on site.-Trailer is for John-Paul Construction`s use only.` A. Payment Schedule Deposit 5000:: Floors Tiled 6,500. 41 Electrical/Smokes Installed 4,500.' Cabinets Installed 11,500. Job Complete Total . 34,884-- .. r . Y.t a � � �ji ref�E ,F• } . ',s.. , This page becomes part of work contract proposal to'! .Tenebaum t ,' July 10,2013 + ,-its • • dated and is in conformity with its terms and conditions. � I C n is Acceptanc f/ ✓` a Owner s`Acceptance s: i ■ Contractor. Dite: II �{ a5 Owner f r s 4{ Date: i ■ r � "Y• _' ''' k -CONTRACT PROPOSALS ` Page 3 of.4 x '' Extra Considerations and Disclaimers Any change orders that deviate from this original contract,propos al:decided upon after signing of said proposal will be. charged at.the full retail-,price of!'ike changes) plus..a $50.00 administration fee. Payment in full for changes) will,be required upon signing•of the change order. Any additional work will beldiscussed with`J_ohn-Paul Construction,. 'Inc. not it's workers,,Any unforeseen. damage or work needed willf a discussed with`the client prior to any additional costs being incurred by the client 47' John-Paul Construction; Inc. will not,be responsible;for damages caused. by existing conditions on the home or property being improved. John-Paul Construction, Inc. will not be responsible for damages caused tiy,cement mixer. drywali.l trucks"dumpsters or any other heavy equipment. °. , 5 It should be understood that all measurements denoted on any plans'or contracts supplied by John-Paul Construction, Inc. are "plus-or minus". These.are not exact measure-, ments and will,not"and cannot be guaranteed due to existing conditions on the home that John-Paul Construction,-Inc. must contend with as the job proceeds. All items provided are "equivalent to" or,"better than" described.,Bringing items or areas "as close a's possible" and "as neat as possible" does not constitute,a perfect match. All costs relevant to the discovery of ledge at the'excavation stage will be the customer's responsibility. Pricing for ledge removal will be discussed and,mutually agreed upon by the customer and contractor should ledge be.discovered: r` John-Paul Construction, Inc. will not be responsible `if concealed or unknown condi- tions of an unusual nature'that affect the performance*of'the work and vary from those indicated by the contract proposal are encountered below,ground,or.,inian existing struc- ture. John-Paul Construction,Inc. will not be responsible for any,water and/or drainage problems encountered.. Drains and/or pumping will be done at.additional cost, which will be discussed and mutually agreed upon by the customer and the contractor, should there 4,be a water and/or drainage'problem. Pumping of any kind; done at.additibnal costs. * It is the client's responsibility to provide a certified plot plan,-of the property being improved, when such plan-is required by the building department,for procurement of a building permit.. It is also the client's responsibility to make John-Paul Construction, Inc.'aware of any setbacks or frontage deviations, wetland/conservation issues, or any other property.-,related issue(s) which may complicate the process of-obtaining_a•Abuilding„•permit. John-Paul 'Construction, Inc..c,annot be responsible for any additional `requirements of.,any town agencies. '+ John-Paul Construction,'Inc. is not responsible for any,complicationsfto allow access to the job site, resulting from any situation; including site'and'weather conditions. yr John-Paul Construction,.nc. is not responsible for any p1roblems and/or additional cost incurred resulting from plans`drawn or 'supplied b'y anyone other than-John-Paul l - Construction, Inc: , Heaters and fuel for heaters supplied at additionalycost.� i This page becomes part of work contract proposal to Tenenbaum i dated July 10,2013•+ and is in conformity with its terms and conditions. C 's Acceptance Owner`s°Acceptance .c ■ �_ z 14113. Contractor: Date: sOwner Date: ■ CONTRACT RROROSAL�•� is l _ r r :,� Page 4 of 4 ; ♦ t f t Project Administrative Procedures • - :.{ - To avoid delays in your project, it is imperative, for administrative'and.scheduling reasons, that .the following.procedure's are followed though'.0'ut•the' 'entire"project.,W6 strive to make our projects run as smooth as possible, but you must understand, John-Raul Con— struction, Inc. could have additional projects in progress sim"ultaneouslyc=We have our schedule, our subcontractor's schedules and'variouys-other,constraints>'to work around daily. It is our only request that you work with us_ and our schedule to.ensure proper and timely completion of your project. . s. .' `�:- r , Payments: Payments should be made to the project foreman, on the day they are due. Please refer to your payment schedule in your conract. Please make-'all necessary'bank deposits and/or transfers several days prior to the,I payrnent due date. itis very-important;to follow the payment schedule as the project will not progress.unless the payments are made timely. Change orders . A change order request form must-be completed by-the homeowner,,and,given to the project foreman, prior to any additional,work being priced or.performed. See,attached copy. ,. a.• . Correspondence ", k�• ; ' In construction the days start early. Our business hours are 7:00a.m,,.. �,5.00p.m. We want to be there to answer all your questions and concerns, but our business day must end at a reasonable hour. Therefore we need to-schedule.project meetings;;wafk-thrust job pro- gression and punch list meetings during normal business hours: Getting together in the morning before work, or on lunch hours, has proven oto be successful with other clients. { Homeowner Interface The homeowner must wait until the project is complete before the homeowner work is performed. This includes painting, landscaping, etc. The ;homeowner is responsible to protect, cover or relocate any and all flowers, plants,shrubs,furniture 'etc.....From area/ areas to be worked on. This should be done when the contractl,s signed Contractor can not always forewarn homeowners when°particular work'will-take place. John=PaulCon- struction,Inc. is releived of`any and all liabilities concerning the aforementioned. This page becomes part of work contract proposal to 'Tenenbaum - z Jul 10,2013 - - `- dated - -,and is in conformity with its terms and conditions.. � ti♦ 's Acceptanc e'- Owner s'Acceptance / 3 ; t f t' ■ ® Contractor. Date: owner _ Date. . I, ' CONTRACT PROROSAL { Page 1 of 4 Date: July 10, 2013 We herewith submit proposal for materials and labor to be supplied at the role requestand order of: Name: Home Phone: Job Address: I Ms Judie Tenenbaum c f j It 5 Bacon Street J — HN-P/�UL Address: Office Phone: (Orth Andover, MA /-� 20 Upton Avenue NS Hereinafter ther:Providence, RI 02906 oS 4?3 Job Name: Tenenbaum Hereinafter referred to as owner,to be performed at premises set forth above,according to the following terms and specifications: Contract •!! to : Remodel Supply materials and labor to install kitchen and two baths as discussed. Contractor is responsible for plans, permit and necessary inspections. If needed,owner is responsible for a Plot Plan and any additional information/engineering as required by the building department. Clean, prep and paint fiberglass shower and tub/shower units in baths, white is recommended. Nail off existing plywood floor sheathing in kitchen and both baths with 8d ring nails.This is done in an attempt to minimize/if not eliminate any "squeaky floors". Supply and install 3/8"plywood to kitchen and (upstairs)full bath floor,scrape and prep concrete slab in basement bath prior to the installation of ceramic/porcelain tile. Tile for basement bath, hall and utility room is "Anatolia" 13"x13" Portofino Beige.Tile for 1st floor(master bath-up) is "Anatolia" 12"x12" Classic Carrara, Tile for the kitchen floor is "Anatolia" 13"x13" Prato Ivory and backsplash the is "Anatolia" 3"x6" Prato Ivory. Supply and install one 36"JSI Dover style white vanity in 1 st floor(master bath). Supply and install "JSI-Salem"cabinets with cherry stain-standard overlay shaker style door with slab draw fronts. Cabinets are all wood construction and have standard wood draw boxes with side mount drawer runners.Supply and install "Santa Cecilia Light"granite top with single bowl stainless steel undermount sink in kitchen. Granite will be finished with a standard "bull nose"edge. You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached Notice of Cancellation form for an explanation of this right:. . , All materials are guaranteed to be as specified and to carry manufacturer's warranty.All work to be completed in a neat and workmanlike manner.Any alteration or deviation from above specifications involving extra labor and/or materials costs will be executed only upon written order from the owner or his/ her authorized agent and will become an extra charge over the below agreed amount.Agreements made with mechanics or subcontfactors on the job are not - - recoglnlzed.Na statement.arrangement or understanding,expressed or implied not contained herein will be recoprirzed, We propose to furnish and install the above complete in accordance with the above specifications for the sum of: Thirty-Four Thousand Eight Hundred and Eighty-Four and 00/100 Dollars 1$34,864.00)Payment to be made as follows: Balance of payments to be made as follows: See payment schedule page 2. Total Amount $ 34,884.00 Customer must cooperate with JOHN-PAUL CONSTRUCTION,INC. in Deposit $ 5,000.00 the fullest for performance of payments and work procedures with the regard to said job.Any delays on the customer's part will slow procedures of the job Balance $ 29,884.00 and constitute delays on the part of JOHN-PAULCONSTRUCT[ON,INC. due to the resulting change in our schedule. Contractor's Acceptance Owner's Acceptance Work to be started on or before J lR L ! Zee f l The foregoing terms, specifications and conditions are satisfactory and are 4. r-2 ?.r:�j hereby agreed to.You are authorized to do the work as specified and payment and be substantially completed on or before �,,��� q will be made as outlined above.The owner upon signing this agreement repre- Company Representative �' � � �Lic. sents and warrants that he/she is the owner of the aforesaid premises and that he has read this agree ent- Accepted by Contractor tic.R ST 7-LS—','A ® yJ Owner: Date: This proposal may be withdrawn if not accepted within 3 days r� - Owner: Date: a 2543 Main Street Tewksbury,MA 01676 976.657.6007 CONTRACT RROROSQL Page 3 of 4 Extra Considerations and Disclaimers Any change orders that deviate from-this'original contract proposal decided upon after signing of said proposal Will be charged at the full retail price of the change(s) plus a $50.00 administration fee. Payment in.full for change(s) will be required upon signing of the change order. Arty additional work will be.discussed with John-Paul Construction, .Inc. not it's workers ;Any.unforeseen damage or work needed will be discussed with the Client prior to any additional costs being incurred by the client. John-Paul Construction;Inc. will not be responsible for damages caused by existing conditions on the home or property being improved. John-Paul Construction,Inc. will not be responsible for damages caused by cement mixers, drywall trucks, dumpsters or any other heavy'equipme'nt. ' it should be understood that all measurements denoted on any plans or contracts supplied by John-Pa.ul Construction, Inc_ are "plus or minus". These are not exact measure- ments and Will notand,cannot be guaranteed due to existing conditions on the home that John-Paul Construction, Inc. must contend w. ith as the job proceeds. All items provided are "equivalent to`'.or."better than" described. Bringing items or areas "as close as possible" and "as neat as possible" does not constitute a perfect match. AlLcosts relevant to the discovery of ledge at the excavation stage will be the customer's responsibility. Pricing for ledge removal will be discussed and mutually agreed upon by the customer and contractor should ledge be discovered. John-Paul Construction, Inc. will not be responsible if concealed or unknown condi- tions of an unusual nature that affect the performance of the work and vary from those indicated by the contract proposal are encountered below ground or in an existing struc- ture. John-Paul Construction;Inc. will not be responsible for any water and/or drainage problems encountered, Drains and/or pumping will be done at additional cost, which will be discussed and mutually agreed upon by the customer and the contractor, should there ,,be a water.and/or drainage problem. Pumping of.any kind, done at additional costs. 'It is the client's responsibility to provide a certified plot plan.of the property being improved, when such plan is required by the building department for procurement of a building permit. it is also the client's responsibility to snake John-Paul Construction,Inc. aware of any setbacks or frontage deviations, wetland/conservation issues,or any other property-related issue(s) Which may complicate the process of obtaining a building permit. John-Paul construction, Inc. cannot be responsible for any additional requirements of any town agencies. ,John-Paul Construction, Inc_ is not responsible for any complications to allow access to the job site, resulting from any situation, including site and weather conditions. John-Paul Construction,lint..is not.responsible for any problems and/or additional cost incurred resulting from plans drawn or supplied by anyone other than John-Paul Construction,Inc. Heaters and fuel for heaters supplied at additional cost. 17iis gaga Qerontes part of work Qnotrart proposal to Tenenbium July t0,2073..., .dated and is in conformity with its terms and conditions. C t 's Acceptance Owner's Acceptance . f / [S7" a contractor: Dale: + f Owner:„�'� Date: b ; CONTRACT RRQROSA►L Page 2 of 4 � r Supply-and install twa white"Kohler"comfort height toilets with seats. Supply and install one-`Xohler",kitchen faucet,arid two"',Kohler"lavatory faucets. Supply and install a one piece sink top on 1 St flooi(master bath),vanity. Supply and install one white pedestal sink in,down stairs(basement)bath,. Supply and install two bath exhaust fans vented.outside as per code. Supply and install new electrical,devices (plugs and switches) as per code requirements. All devices will be white devices standard specilic.ation (toggle/residential grade). Fixtures (including bulbs)will be supplied by owner and installed by electrician. Supply and install necessary wiring and detector devises(upgrade existing smoke detec- tor system)aspen code requirements.This includes battery back-up hard wired smoke/ heat and carbon monoxide detectors onboth floors of house and 2 heat detectors in the garage. Clean up and disposal of construction-debris resulting from above described work in trailer locatedon site.Tfailer is for John-Paul Construction's use only. Raymelm Schedule Deposit 5000. Floors Tiled 6,500. Electrical/Smokes Installed 4,500. Cabinets installed 11,500. Job Complete 1,884. Total 34,884 This page 7ecomos part of work contract proposal to Tenebaum f dated^July 10,2013r and is in conformity with its terms and conditions. C is Acceptanc Owner's Acceptance ., � S—t Contractor. owner:s�"�"� gate: CONTRACT PROPOSAL Page 4 of 4 7,77;77 � '`a x v t, 'gig-` „'` ,'z ' '.. �` ..,, . Pi40je t AdMilhistrative.Procediures To'avoid delays£in your project, i is imperative,for administrative and scheduling reasons,. that the following `.procedures are followed though.but the entire project. We strive to make our pro}ects run'as smooth"as possible' but you must understand, John-Paul Corr strucbon,In,^..,could have.ad, itiona( projects in progress simultaneously. We have our schedule, our,subcontractor`s schedules and various other constraints to work around daily. It is our:only request that you`work with.us and our schedule to ensure proper and timely completion of your project. Payment*... Payments should-be made to the project foreman, on the day they are due. Please refer to your payment.schedule in your contract. Please make all necessary bank deposits and/or transfers several days prior to the payment due date, it is very important to follow the payment schedule as,the project will not progress unless the payments are made timely. Change`orders A change order request form must be completed by the homeowner, and given to the project foreman, prior to any additional work being priced or performed. See attached copy. Correspondersce In construction the days start early. Our business hours are 7:00a.m. -,5:00p.m. We want to be thereto answer all your questions and concerns, but our business day must end at a reasonable,hour. Therefore we need to schedule project meetings, walk-thrus, job pro- n'gression and punch lisf meetings during normal business hours. Getting together in the AtmOrning before.work,or on lunch hours, has proven to be successful with other clients. Homeowner Interface The homeowner must wait until the project .is complete before the homeowner work is performed .This includes painting,,,landscaping, etc. The homeowner is responsible to protect, cover or relocate any and all flowers, plants, shrubs, furniture, etc.....From area/ areas to be worked on. This should he done.when the contract is signed. Contractor can not always forewarn homeowners when'paricular work will take place. John-Paul Con- struction,Inc. is releived of any and all liabilities concerning the aforementioned. This page becomes part of work contract proposal to Tenenbaum dated J'iv 10•2013. end is in conformity with hs Terms and conditions. is Acceptanc ,y Own is Acceptance SY ' Contractor. Date: �r J Owner. Date:? k' t i TOWN OF NORTH ANDOVER APPLICATION FOR"PLAN EXAMINATION Permit NO:b, Date Received Date Issued' ' MP RTANT:Applicant must complete all items on this page z L.00ATIQNCr�x1_ .✓ - Print PROPERTY OWNER_ &VTJ _r r 'Print 10o-Year'Old Structure yes no MAP NO: . _;PARCEL: .Y;_J ZOMNG DISTRLCT A,_-Historic District yes no Machine Shop Village, yes no, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ' ❑ Commercial 9 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: Phone: Address: ONS '42tc �o7v�fie 97?� ;5 Z79 CONTRACTOR Name: _. _;t-}n? .gip w �' '._ _ _ Phone:. 9 7f - 4_!r7- ,64z)_'7 Address: 2;'�f3 Supervisor's Construction` License:. _ Exp. 'Date: _//-27--ZU/..3�- - - - - Home Improvement License: /01-/ _Exp. Date:__7::�ib- 2-0/ el _ ARCHITECT/ENGINEER Phone: a 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: $ 0 Q FEE: $ II Check No.: Receipt No.: a6(as:-9- NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty fund ;Signature of.AgentJOwnery Slgature,of contractor �y ' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE:DiSPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ ' t` Tobacco Sales ❑ Food Packaging/Sales ID Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments j Water & Sewer Connection/Signature& Date Driveway Permit DPW Tovv : Engineer: Signature: Located 384 Osgood Street FIRE DEPARTME'N't Temp Dumpster on site eyes_ no Located at 124 Mair; Street :. Fire Departme'rf.signdture/ddtd" COMMENTS gX` Location Date • TOWN OF NORTH ANDOVER Certificate of Occupancy $ J s Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � 26 �j82 7 ! Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Q — Date Received Date Issued: 01 IMPORTANT: Applicant must complete all items on this page .. LOCATION Pt PROPERTY OWNER o u <3 Thi�hA-tii M - Print !00-Year Old structure yes no MAP NO: 4!�PARCEL: ZONING.DISTRICT Historic District yes no Machine Shop Village yes no _ TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ElAlteration No. of units: 11 Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands. ❑ Watershed District ❑Water/Sewer _ _ DESCRIPTION OF WORK TO BE PERFORIgD: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: 2S' f E - K1' 0/!�76 - - Supervisor's Construction License: Exp. Date:_ Home Improvement License: _ _ Exp. Date- ARCH ITECT/ENGINEER ate:ARCHITECT/ENGINEER Phone: I Address: Reg. No. 4 FEE SCHEDULE:BULDING PER T:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ qk i Check No.: � Receipt No.: C,_zw" _ NOTE: Persons contracting with unregistered contractors do not have access t athe ,&arun Signature ofe 'gent/Ownerf SRg-ature.of contractor, - i Plans Submitted ❑. Plans Waived ❑ Certified Plot Plan ❑ amped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ "TYPE ORSEW-ERAGEDISP.DSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. . .Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc.. ❑ - Permanent Dumpster ori Site ❑ THE FOLLOWING SECTIONS FOR-OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I -DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENTS ❑ ❑ j COMMENTS i CONSERVATION Reviewed on Si natur COMMENTS HEALTH Reviewed on Signature COMMENTS "r 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 To-wo Engineer: Signature: Located 384 Osgood Street FIRE DEPt40Ti�l;relt9T = Temp Dump'ster on site yes no Located-at 124 Mair Street --; Fire"Departmer' #sigmture/date '` -+ x^ COMMENTS , NORTH Town of tAndover O 0 Z o h , ver, Mass, coc"Ic"twicw �,9 A�R�1TE0 PPP��S S u BOARD OF HEALTH Food/Kitchen PERMIT -T L.D Septic System THIS CERTIFIES THAT a�,,11,,�,,,,,,,,,,,,,,'.�'r, lM.. .Pvjw........................... BUILDING INSPECTOR has permission to erect buildings on `,... re*P r Foundation Rough I�-+�. t.�...u.... ..� .. . .... ... 1 .. 'i.�C. to be occupied as ........... ..... .... . ....... Chimney provided that the person accepting this permit shall in every respect con 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 CONSTRUCTIOMST S 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. SEE REVERSE SIDE Y M P.T. 2x . 16' G.C.oo h /\ P.T, 240 LE GE , L GGE AD F ASHED JL JL JL JL JL JL JL JL JL JL JL JIL JL JL JL Jl l � � �- Sz � J s� 244��J rip t9- -cs c- 6 2x lf /-5/4x6 . 2x10 P.T. JOIST ON HANGERS AS NECESSARY . LAGGED AND FLASHED TO EXISTING HOUSE 4x6 PRESSURE TREATED POST evi POST ANCHOR 0 p �p a p ° GRADE \0 Ao p ° p p ° 12°' SONAR TUBE FOOTING v ° ° o 4'MINA ° o p 0 0 ° ° 14 x12' DECK p ° a° o p o � ° o SIZE ' �` DATE: 7--T ;�3- e� A X l � D E"K SCALE: NONE �� ®�= CLIENT: � FILE NAME: 287b.DWG REV. A SHEET 2 OF 2 r DC Typical . I 4D o �o PAD Completed Stairs With Treads And Enclosed Risers i North Andover MIMAP 5 Bacon Ave September 9, 2013 h I II � e All � U k .It + j e m I ,. , ,v rt x t . J � � . f ;49 �-fir` z: 4 n k T' •*� � � d N`a gib � y � L Yf V Interstates Inters ate Major Roads Horizontal Datum:MA Staleplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack 9 Easements t ,AORTN q - Valley Planning Commission(MVPC)using data provided by the Town of O �p North Andover.Additional data provided by the Executive Office of 0 MVPC Boundary ? 9.�t� y�OO Environmental Affairs/MassGIS.The information depicted on this map is p Parcels3 L for planning purposes only.It may not be adequate for legal boundary o definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING 41 >r THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY • i ,^, OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION SSACMUS� 1" 28 ft „�, The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �d� �i4'�?� ( c r�.� e_f Z-c G'1 . Address: - City/State/Zip: S LC/0 1wJ71b Phone#: 17ff- Are you an employer?Check the appropriate box: Type of project(required): 1.®'I am a employer with 4. ❑ I am a general contractor and I �— 6. FJ New construction employees(full and/or part-time).* have hired the sub-contractors 2.ElI am a sole proprietor or partner- fithe attached sheet. 7. E]Remodelingsted on h ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9 ❑Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.E]Roof repairs insurance required.]t employees.[No workers' 13.[i 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 a-re doing all work and then hire outside contractors 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. ,/ Insurance Company Name: , ✓l,6� Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: VA",a I`1 dc City/State/Zip: 7-&W 4. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA-for insurance coverage verification. I do hereby cert d r the nd pen ties of perjury that the information provided above is true and correct. Sip-nature: Date: Phone#: ?7F- Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massa..chvsetts Department of Industrial Accidents Office of Iavestigations 604 Wasbington Stre.et Boston,M.A.02111 Tel,#61.7-727-4900 ext 406 or 1.-877�,MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.govldla 1, Vlte �Ga�azaaaaaicoe¢CC�o,� S Office of Consumer Affairs&Busihess Regulation t OME IMPROVEMENT CONTRACTOR — eg,istration: 104989 Type: +^ PrivateiCorporat( xpiration: 7/1672014: , �. " JOHN-PAUL CONSTRUCT ON INCzi John Berube _ ' 2543 MAIN ST. TEWKSBURY, MA 01876 ' Undersecretary `' . k t . >V ix3 L%f tssurhttsetis-.Det itrtrttent of Pul)lie Safety Bo rd of Building Reutttations anti Stanilarcls ' Construction Supervisor License License: CS 54969 1 lV4, JOHN F BERUBE 2543 MAIN STREET - — TEWKSBURY, MA 01876 Expiration: 11/27/2013 t .Rtmi�Qi.>ner Tr#: 7062 i i 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 crop 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 El Notified foricku - Date p p E Doc.Building Permit Revised 2010 �i 1 I i I I { e Building Department The fol,-swing is-a-:list of the required-forms to be filled out for the appropriate.permit to be obtained. Roofir g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 I Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) Li 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 ❑ Photo of H.I.C. And C.S.L. Licenses ❑ 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 o 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 apw-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.tted with the building application Doc: Doe.Bui ding Permit Revised 2012 j ! i I North Andover Board�of Assessors Public Access Page 1 of 1 NORTH North Andover Board of Assessors Of tT�e°,°'LyO * 9 # 01— C US roperty Record Card Click Seal To Return Parcel ID :210/045.G-0057-0000.0 FY:2013 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels w Search for Sales �• � ` n1 E _ Summary _ Residence z Detached Structure Condo 5 BACON AVENUE Commercial Location: 5 BACON AVENUE Owner Name: TENENBAUM,LEWIS L E MARJORIE TENENBAUM Owner Address: 5 BACON AVENUE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5-5 Land Area: 0.30 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1226 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 289,900 310,300 Building Value: 123,900 140,000 Land Value: 166,000 170,300 Market Land Value: 166,000 Chapter Land Value: LATESTSALE Sale Price: 97,900 Sale Date: 11/06/1981 Arms Length Sale Code: Y-YES-VALID Grantor: CRESTWARD DEVELOPMEN Cert Doc: Book: 01544 Page: 0206 http://csc-ma.us/PROPAPP/display.do?linkld=2253068&town=NandoverPubAcc 10/29/2013 Residential Property Record Card PARCEL ID:210/045.G-0057-0000.0 MAP:045.G BLOCK:0057 LOT:0000.0 PARCEL ADDRESS:5 BACON AVENUE FY:2013 PARCEL INFORMATION Use-Code:T 101 Sale Price: 97,900- Book: 01544 Road�Type: T-' :Inspect Date: 05/12/2011 Tax Class: T Sale Date 11_/06/81 Page_ 02.0.6 Rd Condition P Meas Date 05/12/2011 Owner: - - -- NENBAUM, LEWIS L Tof Fin Area 1226 _ Sale Type L Cert/Doc -- Traffic M TEEntrance: X E NENBA IE TENENBAUM Tot Land Area 0.30 Sale Valid: Y T Water 0 Collect Id: RRC ,. Grantor: CRESTWARD DEVELOPMEN Sewer 'Inspect Reas: "�C Address: _ 5 BACON AVENUE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: RR Tot Rooms: 7 Main Fn Area: 1226 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R4 Story Height: 1.00 Bedrooms: --4 Up Fn Area: BsmtArea- 1188 Seg Type Code MethodV Sq-Ft Acres Influ-Y%N� Value Class __,...- s:. _� _ -.._ __. ? 1 P 101 S 12500 0.290 165,880 - Roof:- G""" Full Baths: "`2®"Add'Fn Area: Fn Bsmt Area: 567 L - Area-: _.__. 2 R 101 A 0 0.010 76 Ext Wall: FB- -Half Baths: ��. Unfin Area: Bsmt Grade: Masonry Tnm Ezt Bath Fix 0°" Tot'Firi Area: _—U26---- Fou- 1226p VALUATION INFORMATION Foundation CN Bath Qual: T RCNLD:'- 123894 Current Total: 289,900 Bldg: 123,900 Land: 166,000 MktLnd: 166,000 ,w Kitcli Qual: RT�"Eff Yr Built 1980 Mkt'Adt.-- Prior Total: 310,300 Bldg: 140,000 Land: 170,300 MktLnd: 170,300 Heat Type: i HW Ext Kitch: Year Built: —1981— Sound Value: ,-er-_ �,.,_._ _ ..r -- _Fuel Type:_ _G � Grade: A Cost Bldg:"_ 123,900 ; Fireplace: -1 BsmtGar'Cap:"1 Condition: A -Att Str Val1: ' Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Aft Gar SF: %Good P/F/E /R: ' /100/100/78 Porch Type Porch Area Porch Grade Factor W 168 SKETCH PHOTO 14 . 12 168:Sq.F z 'fs � 14 44 FM/13 �'3 1188 Sq.Ft 27 27 5 BACON AVENUE - P. 1 15 Sq.Ft 23 Sq.Ft Parcel ID:210/045.G-0057-0000.0 as of 10/29/13 Page 1 of 1 Date.. .(A ........................ CF NOR TN TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION g$ACHU This certifies that .... . .... o���'` ............................................................ ........... has permission for gas installation ."^\M.................. .. ..., .!..�� ........ in the buildings of. F'. '1L. .cc u v,n...................................................... at........... �..�.... c:... ........................ North Andover, Mass. Fee..4(%.I ... Lic. No. .5.1.%...... ................................................ 61 GASINSPECTOR Check# 104n 9295 b MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ICITY I N.Andover MA DATE 51612014 P RMIT# C JOBSITE ADDRESSI 5 Bacon St OWNER'S NAME GOWNER ADDRESS I Same I TEL— FAX TYPE OR OCCUPANCYTYPE COMMERCIAL® EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES® NOQ APPLIANCES 7 FLOORS- BSM 1 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 =L JM OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER �• UNVENTED ROOM HEATER WATER HEATER 1 OTHER -------------------------------------------------------------------------- 1 -- Replace Gas Meter x and Pi inq as Needed INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY F 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. 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 to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be i co Hance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ljoseph Marino LICENSE# 8736 SI NA URE MP E] MGF® JP® JGF® LPGI® CORPORATION E]# 3285C PART ,E SHIP®# LLC®# COMPANY NAME: RH White Construction Co =ADDRESS L41 Central St CITY I Auburn STATE MA ZIP 01501 TEL (508 832-3295 FAX 508-926-4347 CELL 508-832-4614�EMAIL JMarino@RHWhite.com WAA / L ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES , �.r y fy 7 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES -=:GCEALTH OF MASSA.G.�$Ut S �irg -P1YJI�SERS AND GASFIT`J'E.RS •' -_ -- .TSR issuES E. E, 10ri JO`SEl H. D -MA-R.INQ _ ITJGTON ST Wt7'RE'STR MA 0' `�` 85/01/14 T=~=`C,�itt9l111DNWEALTH OF dU�ASS/kC'latUS:EI tS'- ; = c. `PLUIVI13ERS AND GASFITTER' I L;i'CEN "D AS A JCIURNE1lNFAN R#.UI4 `�3 --: UES THEABOVl�LIGENSE70 :N➢'AR 1 ... =3 Fi4RR_Z=NG f0f ST• . tip= 05/01/14 I i Cl4/C13/LCIl'i lY.U4 JCI00J40/Jl M" WrllIC UUI131ICUI,I 1-HUC CIL/CIL CERTIFICATE OF LIABILITY INS URANCE page 1 of z 08/29/2031 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the polioy(ies)must be endorsed, if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does notconferrights to the certificate holder in lieu of such endorsoment(s). PRODUCER CONTACT NAMF- rvilliq of Massachueette, Inc. PHONE C/o 26 century Blvd. 11. 877-945-7378 PA%_NO) 888-467-2378 R. 0. Hoe 3 N 3 DD�ESFi-��X G�fiCat:e�9(�W�l��B_EOM NdAhoille, IN 37230-5191 INSURER(S)AFFORDING COVERAGE NAICtt INSURED INSURERA: The Charter Oak Tiro Insurance Company 25615-001 R. H. White Conmkraotion Company, Znc. INSURERS:TrdvO7i Property Casualty Company of Am 35674-003 41 Cmneral Street INSURERC:NatiOnAl Union Firg Snauranca P. 0. Box 257 Company e£ 79445-001 Auburn, MA 01501 INSURER D;Travelers Indamnity Company 25656-DOl INSURER F.; INSURF,R F; COVERAGE$ CERTIFICATE NUMBER:20287680 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. INSR TYPE OF INSURANCE DD' SUB POLICY NUMBER POLICY EFF POLICY EXP yyyn LIMITS A GENERALUABILITY VTC2000 977X9948-13 9/1/2013 9/1/20],4 DEAACHGOCCURRENCE F 2 400 000 X COMMERCIAL GENERAL LIABILITY ftkt B(Es oeCluiancrl CLAIMS-MADE�OCOUR MED EXP(Anyone ereon F 10,000 PERSONAL&ADV INJURY S 2 009,000 GENERAL AGGREGATE $ 4_1Q001000 GEN-LAGGREGATFLIMITAPPLIESi PRODUCTS-COMPIOPAGG IS 000 000 POLICY PRO LOC a AUTOMOBILELTABILITY VT3CAE 977K95SA-13 9/1/2013 9/Z/2014 $ OME3INED5INGLF.LIMIT accident $ 2,000,000 }C ANY AUTO BODILY INJURY(Perpemon) $ AUTOS AUT08ULED BODILY INJURY(Peraccldent) $ X HIREDAUTOS X NON-OWNED AUTOSerPERTnt ^� % Co Ded X Cv11 Ded C UMBRELLALIAB OCCUR BS8766Z40 /1/2013 9/1/2014 EACHOCCURRENCE —L--S-,000,000 EXCESS LIAS CLAIMS-MADE AGGREGATE $ P,000,000 DED I $ IRETENTIONS 10,000 5 D WORKERS COMPENSATION ANDEMPLOYER$'LIABILI7Y RRUB 62054165-13 9/1/2013 9/1/2014 A . o - XT (.Y D ANY PROPRIETOR/PARTNERIEXECUTIVENIA VTC2XUB 8209IA71A-13 9/1/7013 9/7./2014 E.L.EACH ACCIDENT $ 1,000 000 OFFICER/Mi2i EXCLUDED? (Mandatonr In NN) E.L.DISEASE-EA EMPLOYEE $ 1,000 000 UtISUKIIII11UNW-QPRATTONSbelow E.iDISEASE-POLICY LIMIT S 1,000,000 DISC RIPTIOIN OF OPERATIONS I LOCATIONS I VEHICLES(Attach Acord 101,Addltone1 Remarks Sehodula,If more epaea la raqulrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, p'vxdence of rna+uzance AUTHORIZED REPRESENTATIVE Col1:4197604 Tp1:1694012 Ce7:t:202ii ©1988-2010ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Date....... ..... ....... .... .... Itvoo 0TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING certifies that ........ This ceV. ................................... ...... .. ..........................................................4 has permission toperform d /-e/-�- ................................................................................ wiring in the building of............ at .....�.........16"k &IJ.............................................................................../.-Vorth Andover,Mass. Fee... ...Lic. ..... . . ......... ................ ... ... ... 1& -1 KARICAL INSPECTOR ChYck# 11941 commonwealth ®f Massachusetts Official Use Only Department®f Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL) FORMATION) Date: Le j City or Town of: NORTH ANDOVER To the Inspeftor ofMres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number)__ S, ~ 0A Owner or Tenant 6i i e A)EA) _PA zzn Telephone No. y 25 -3,7j3 Owner's Address 5A T Is this permit in conjunction with a building permit? Yes 5a" No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters ° New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I ompletion of thefollowing table may be waived by the Inspector of fires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No. of Total Transformers KVA � No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In ❑ o.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets t;°' No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burgers No.of Detection and \� Initiating Devices t� No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: _...................................................................... Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Other Connection No.of Dryers Heating Appliances KW Security Systems,* No.of Devices or E uivalent No.of Water No.of No.of Heaters KW Data Wiring: Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of fires. ? Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. .INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless N the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I ceNify,under the pains and penalties ofperjury,that flee information on this application is true and complete. FIRM NAME: - c ' LTC.NO.: 3 JQL- Licensee: - .���, D - Signature - LTC.NO.: (Ifa licable,enter exempt' zn the license nacmber line.) Bus.Tel.No.: Address: Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. • OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature gnature Telephone No. PERMIT FEE.,$��' ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.C.143,§3L,the ` permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§ 32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written hall a permitted for reasonable cause.A permit shall be terminated upon the written time for completion of works b application,an extension of tem p P request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,anypermit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: 0 Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL.INSPECTION: Pass® Failed Re-Inspection Required($.) ❑ Inspectors Corn mnts: Inspectors Signature: Date DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth ofMassachusetts - Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA.02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/fndividual): 1 Address: City/State/Zip: 1 ?2 MA Phone#: RLl"g g—Y Are you an employer?Check the appropriate box: Typo of project(required): P.❑ 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.ZI am a sole proprietor or partner- listed on the attached sheet. 'l• El Remodeling ship and'have no employees These sub-contractors have r 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 3.❑ I am a homeowner,doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' 1311 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. T Homeowners who submit this affidavit indicating they tie 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ���� 6�/�h rh— Policy#or S elf-ins.Lie.#: Expiration Date: Job Site Address:_saa6l Gd AJ R 1)4 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL o. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP?WORK ORDER and a fine of up'to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy nder the pains andpenalties ofperjury that the information provided above is true and correct. - Si afore: 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#: I F Information and Instructiolms Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined-as"...everyperson in the service of another under any contract of hire,- express or implied,oral or.written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer" MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance 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 certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In.addition,an applicant that must submit multiple permit/license applications in any given year,need only-'submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as pro of that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture w (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 Commonwealth of MgssaclivsPtts Department of Industrial Accidonts Office of layestfgations. 600 Washingtoa Strcot BostonMA02111 TQL#617-727-4900 eA 406 or 1-87MASSAFF, Revised 5-26-05 Fax#617-727-7749 .F COMMONWEALTH OF MASSACHUSETTS - BOARD-OF EaEC1RICIANS J 1SSUE5 TH1~ FOLLOWING L#CENSE AS A REGI ST.ERE`D MASTER ELECTR•I.C.I A c JEREMIAH J DELANEY 141 PATR I IA DRIVE J y TE.WKSBURY MA 01876 29,18 2 MR95534 eOMMONWE'LTh OF MASSACHUSE o o 0 o TTS; o - j ELECTRICIANS ; G a ISSUES THE FOLLOWING 'LICENSE AS A REG JOURNEY .............} MA;N...E L E .::JEREMiI AH Jc la DELANEY JR f` ;z N 141 PAIR A DR 6 .TE:WKSBURY 186 0 AtA 01876 2918: 1 4 E .... ........ ',F 10196 l Date . ! �I.� (. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING . . c This certifies that . . .r. . . . '�-. . . . . . . . . . . . . . . . . has permission to perform .� � a Z 1 5 1rP P P�f C 4,P7 plumbing in the buildings ofat ,North Andover, Mass. s -�v Fee .��+'"'. . . Lic. No.��� PLUMBING INSPECTOR S Check# �'� 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE j PERMIT# JOBSITE ADDRESS cul OWNER'S NAME `^ P .' OWNER ADDRESS TEL _ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q ED11CATIONAL ® RESIDENTIAL PRINT , CLEARLY NEW: RENOVATION: REPLACEMENT: ! PLANS SUBMITTED: YES Ej NO E-11 FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE ! _..._ ._! f -J ._..__.._-! .. _._ ! .[ -_ _ ....�._.J _ _ __. { �! —5- DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM f __._...! ! DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) =],--I __._.J _____.I KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _C 1 ! i I ! ____ ___.J ---_J ! _€ `CNATER PIPING ! t _f ! ! f _f J - .. I .I OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES IdNO NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY QI 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. CHECK ONE ONLY: OWNER 0 AGENT �1 � SIGNATURE OF OWNER OR AGENT d� 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 �d 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 Co—d�e-and Chapter 142 of the General Laws. PLUMBER'S NAME L_4I!Lfur I, —LICENSE# Z `_. SIGNATURE f� (VIP -I JP[31 CORPORATIONn# PARTNERSHIPD# LLC j COMPANY NAME _NIe ADDRESS 6 —so-- O CITYJISTATE ZIP A TEL Z/ ! FAX CELL o EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL /INSPECTION NOTES Yes No /ntal THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts - Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 W. www.mass gov/dia 'workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib1Y c� Name(Business/Organization/Individual): P&L�-t/L [f�► Address: Ubrl� City/State/Zip: r(1ZiL!n - Phone#: 9X 6(N Cl Z t 3 Ar e an employer?Check tle approliriate bog: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction r employees(full and/or part-thnoj,x have hired the sub-contractors 2.01 am a sole proprietor oror p listed on the attached sheet.x 7• Wemodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers'. 13.❑Other comp.insurance required *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicatingthey tie 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. I am an employer that is providing workerscompensation insurance for my employees. Below is the policy anti job site information. Insurance Company Name Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address- City/State/Zip: Attach a.copy of the workers'compensation-policy cleclaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP-WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of Us statement maybe forwarded to the Office sof Investigations of the DIAforinsurance coverage verification. Ido hereby c t' r t ' s and penaltles ofperjury that the information provided above istrueand correct. - Si afore: 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 M Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as",..every person in the service of another under any contract of hire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two ormore of the foregoing engaged in a j oint 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 lfc�nsing 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 numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' . compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials -P-lease be sure that-the affidavit is-coin-complete rintecl le ibl . The De ai=Ementlias--rovided a s ace at the-bottom* P p g Y P p- P--- of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license 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. s The Department's address,telephone and fax number: Tho Coin gonmmlt�ofWassarhwotts DGp.azt,ent ofl dustdal,A,ccxdonts . �f�ce p�Il��estiga�gns 604 Washington.Street Boston,MA.02111 Tel,#617-727-4900 ext 446 or 1-877,MASS.A.BB Revised5-26-05 Fax#6X7"727 7749 .� ..mss_-=ya a...ra..�. e.�•..�.-r.-. .. .�-�--.._�._-•__N.�r..--....."."��� I Fold,Then Detach Along All Perforations f' COMMONWEALTH OF MASSACHUSETTS BOARD PLIIM:BERS AND GASflTTRS PL LICENS`D AS A MASTER PLUMBER { i IbSUES THE ABOVE LICENSE TO: TYPE PAUC' J PIERCE � I —m _ 36 YOUNG ST En 1 jj 1 TEWKSBURY 14A 01 76-3353 I 172674 . 13.254 05/01/14 1.72674 i p F Fold,Then Detach Along All Perforations a: