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Miscellaneous - 51 BUCKLIN ROAD 4/30/2018
�� 51 BUCKLIN ROAD 210/025.0-0139-000O.p i --- ---- - /. 1 fDate. ��1 �P�........ 10697 NORrH �` •�tio TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 1 ,1 l�tU .� `_ M This certifies that......:... ?......t �............ ..................................................................... y. has permission to perform'... plumbing in the buildings � - ..... .of................................:............................................................ at:..... .....S. .................... ' ...........�. North Andover, Mass.. r � Fee.,�/ ....Lic. No. .... .. !...... . .... ................................................ t PLUMB G INSPECTOR r Check# ��� s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE Cw'-,4PERMIT# JOBSITE ADDRESSL It OWNER'S NAME1 vw OIL FAX OWNER ADDRESS TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW:E3 RENOVATION:__REPLACEMENT:E] PLANS SUBMITTED: YES[] NO[] I FIXTURES I FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE ... ....... DEDICATED SPECIAL WASTE SYSTEM _11... .. .............. ..... DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM ............. ....................... ........ .... DEDICATED GRAY WATER SYSTEM ............. ............ .................... DEDICATED WATER RECYCLE SYSTEM .............. .................... ....3. ........... DISHWASHER ..................... DRINKING FOUNTAIN j FOOD DISPOSER ........... ............ A FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) -7 KITCHEN SINK ........... LAVATORY ... ..................... J ....... ........ ................ ROOF DRAIN SHOWER STALL .. ......... SERVICE I MOP SINK .......... .......... ............ _J_j TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES .......... .... ........... WATER PIPING OTHER .......... JL .......... .... .............. ..... INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142, YES9-<O El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW g LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q 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 E] AGENT SIGNATURE OF OWNER OR AGENT D I hereby certify that all of the details and information I have submitted or enteredregardingthis application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co lance with all PertJnt jP ,,,p provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# SIGNATURE MPO CORPORATION Ej#=PARTNERSHI P E:1#=LLC E]# COMPANY NAME ADDRESS TEL CITYI,./-/ STATE ZIP Lov z > FAX TEL gGq EMAIL ROUGH PLUMBING JASPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTIES Yes No S 3 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES tom. � Be Commonwealth gf ZV.Iassa�husdts . .�e,�a�t.�xeent o,f.�ic��rs�icclAccic�en�� . , 0fflee o,fInvesfigafeons 6`00 Wasftgton Street Boston,MA 02111 uglyrnusYgov/coxa w9r k,us'Compewafzon TusuxalntccAf taavit:SuRdp- igIContractor o)Eloctr Iclansl?I*bex.p ,A,,pplzcant Wo x na-gon Phase�'xint Le�ibXy Na17I.e(Bust aesdorgaui'zaaonlx &1dual): 4Q��t� Cit/Statc/gip: �ZPhow M F 7 9 3 7.7 .2, Are yorx an employer?Check the appropriate Yoox. Type of project(required) �, El Z am a general contractor and S 1,[( � ennployex with _. 6. El New c6nstrt7.ctioxc e ployees( ltandloxpart time)T lihave,nedthe sub-contractors + ed on attached she � 7.2, ana.a solepropxietax orpaxtnex st ❑Remodeling _ slip and`liavena.employees Thesesuis-contxactoxshave 8. [(Demolition woxki�ag forma in any capacity. workers'comp.insurance, 9, �(Building addition [No workers'comp.Jnmauce 5. ❑We axe a corporation and its 10.❑Electrical repairs or additions I equired.] officers have exexcised.their 3.El Z aro.a homeowner doing all work right of exemption per It % 11=�bingxepairs or additions myself:ENO workers'comp. c.152,§1(4),andwehaveno 12.Q Roofxepairs i�+ rauc�xequixed.]Ti employees.[N'oworkus' 13.0 Otlier u comp.insurance,required.] gnrapplicantthat checks box 01 must also M.6-atthosection belowshowingtheirworkerecomp mafionpolicy iuformafim Homeowners who submit ibis affidavit indicating ffiey Aja doing aa worvand then no outsido contractors mus t sulrmft a now affidavit Indicatifig Woh. Tcontractors that ohe,Atbh bCMMUSt attached an additional sheetshowingfhe�ama ofthesuit-confracfors andtheirworkers'comp.policyh formation. X anernproyeNthatisprovldingwor'ket-s'comgexasationznsrimeefor.r,2yempfoyees .BolotvWhepolleyandjobsite information. insurance Company Name% Policy#or Set ins.Lic.#: Expixatxon Data: lob SiteAftess'"572- .A_ttach,a copy of 4e,workers'copzpensation-p olxcy tleclaratiorR page(showing the policy number and e iratiorx date). )`ailuro to securer coverage as xequimd.under Section 25A.ofMCIL o.152 can lead to the imposition of cxhAalpenalfzes of a fm e,rcp to$1,500.00 andror one-y ear imprisonment,as wallas civil penalties in the form ofa STOP WORK ORDER.and a fine o£u.p to$250.00 a day againstthe violator. 33e advised that a copy of this statementmay be foxwardedto the OfCxce-,of- investigations finvestigations of the DIA.for insurance coverage verification. ado ere" cep i �ide�tlie ins and artier of pe ' tliattlie info �natior�pYovided`ali Ve is zee and eorxeet, Si atare: Date: 'hone#• 9 70Q (�`t =Z� 0jf1claZ use ogly, .Do notV11te in Alis area,to be!completed by city or town official: Cffy or Town: Permit/License# �ssuing.A.ufliority(circle one : 1.Board of Health 2.BuildingDepartment 3.Cily fowA Clerk 4.Electrical Inspector S.Plumblug luspector f.Other - - - Informaflon and instructions Massachusetfs General Laws chapter X52 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as",..every person.ui the service of mother under any contract o9bire; express orimplied,oral orwritteO, An eraTloyea is dof mod as"an individual,liartnership,associatioxt,corporation ox:otberlegai entity,ox any two oxnloxe' ofthe oregoiug engaged in a joint enterprise,aad includingt o legalrepxesentatives of a-deceased employer,.or tie receiver ou trustee df an i dividual,partnership,association or other legal entity,employing eunployees, however the owner of a dwelling house having notumoxe than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction.or repair wor1C on such dwelling house or onthe grounds orbuRding appurcenantthereto shallnot because of such employmentbe deemed to bean employer." MGL chapter 152,§25C(6)also states that"every state or local lie-ensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to comstruet buildings in the commonwealth for any applicant who has not pro drxced.acceptablo evidence of compliance with the Insurance coverage required:' Additionally;M chatex 152,§25C(7)states"Neither the commonwealth nox any of its political subdivisions shall enterinfoany contractfor theperfor7manceofpublicworkuntil acceptableevidenceofcormgl ncewith the iusuran:ce requirements ozthis chaptexhavebeempresentedto the contracting authority." .Applicants Please fill out the workers'comp ensaiion affidavit completely,by checking the boxes that apply to your situation and,if necessary,supplysub-confractor(s)mame(s),addresses)and PhoneMumber(s)along wMtheir certiixcate(s)of insurance, Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees outer than the members orpartners,arenotrequiredto caxryworkers'compensation insurance. Sian LLC orLLP doeshave employees,apolicyisrogi red. Be advised thattbisaffidavit may besubmitted tothe,Departmentof lndustdal Accidents fox con fination of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should b e returned to the city or town friar the application for thepennit or license is being requested,not the Do�at-tm.errt of i Industrial Accidents. Shouldyou have any questions regarding the law or if you axe xeq*ed to obtain,a workers' ` eompensationpolley,please,call theDepartment attbenumborlistedbelow Selfinstrxedcompaniesshould enterthaxr Self-insurance license number on the appropriate line. Qy or Town Officials Please,besuxethatfhaa£`izdavifiscompletomdpxintedlegibly. The Department hasprovidedaspace atthebottom ofthe,affidavitfoxyouto fill out in tho event the Office Of.htvestigationshas to contactyouregardingthe applicant. Please be-sure to fill inthe permit/license number w1dchwill be used as a reference number, Zn addition,an applicant thatunust submitmuXple permit/license applications in any given.year,need only subunit one affidavit indicating cutxent policy information(if necessary)and under"Yob Site Address"the applicant should write"all locations in .(city or towh.):':A:copy dthe affidavitthat bass been oflzclally stamped oxmarkodby the city oxtovvM.may bepxovided to the a pplicantasptbo£thatavalidaffidavit•'.*onfdae orfaturepemlitsorlicenms. .Anewafffdavitmustbefilledouteach year.'Where a home ow.nex or citizen is obtaining a license ox b emit not related to any business or commercial venture (i,e,a dog license ori ot mit to burn leaves eta,)said person b NOT required to complete this affidavit, The Office of fnvest gations would like to fbank you in advance for your cooperation and sb.ould you haveany questions, Please do riot hesitate to give us a call The Departm.ent's address,telephone ahA faxnumber. ` 'aTha CQoxaW.J*tjL OfM a chv.:sP Moe dImStWo.)[m 6QGWasgaol? txe-t O*n,,MA 42111 TO 617n7-2'�,49-00 at 406 Qx z•-877-MASSA 'F .Revised 5-26-OS Fax#617"727-7749 e v w4aagov Y.hxa � Safety Insurance Form of Notice of Casualty Loss -to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman . City Hall City Hall N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: Insured: MiNSUR DAHOD and,-RUBAB DAHOD Property Address: 51 BUCKLIN RD,N ANDOVER, MA Policy Number: HMA 0233969 Claim Number: BOS00043734 Date of Loss: 6/22/2014 Company: Safety Indemnity Insurance Company ' Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable"If any notice'under Mass: Gen:'Laws, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Justin Woodworth Claim Examiner 6/24/2014 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3317 Fax: (617) 531-6655 Email: JustinWoodworth@Safetylnsurance:com` ` Date. . . . t' TOWN OF NORTH ANDOVER ` PERMIT FOR PLUMBING ��� +O••no�O�`q9 I .. SACNUSE� This certifies that . . '#t'ir!+'.t. . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . /�€. . . . . f' . r-t . . . . . . . . . plumbing in the buildings of . R4?5QK. . . .,a . . . . . . . . . at . . . . . . . . . .. North Andover, Mass. PLUMBING INSPECTOR Check !1 i 7048 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location 81101'e-41-41 4g Owners Name 1*14Al SUS 7 411a/,, Permit# `off Amount Type of Occupancy New Renovation Replacement ® Plans Submitted Yes 1:1No 1:1 FIXTURES Cr a x w A a E"' U a A A SLREE E &�SFIVVFNr ISIC FIDOR MD HtOC R 31 IILOCR 41H FIDCIEt 5M HDCR 6M TWOR 7M FUM 8M HA" 'ELL-ELL, (Print or type) Check one: Certificate Installing Company Name �i9 LLo A,q.✓ /��t/ ❑ Corp. Address Ro Partner. Business Telephone 97X 6, S"-95-10 y � Firm/Co. Name of Licensed Plumber: 'W NS A109//—,p Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity E] Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Plumbing Code and Chapter 142 of the General Laws. By: igna ure o icense um er Title Type of Plumbing License F-3City/Town icense TNumocr Master ❑ Journeyman APPROVED(OFFICE USE ONLY Uli I I Date. . . . . ...... . I€-� NORTh pE.�`aO ,e,ti0 TOWN OF NORTH ANDOVER 49 PERMIT FOR GAS INSTALLA ON ♦a0��Ph SS CH This certifies that . . . . . . `. !. . . . . . . . . . . . . . ..�_ .T.l.has permission for gas installation . . . t�.� �. . . .x-1. . . . . . . in the buildings of . � Sui!. . . `jOd. . . . . . . . . . . . . . . . . . vE at . . .�f. . . . v. . . .t!! . . /. . . .... . . . . Nor-�tth�Andover, ass. Fee. �. Lic. No.d` . . .ate- -.. . . � GAS INSPECTO�R� Check# ¢' 5670 MASSACHUSErIS UNIFORM APPUCATON FOR PERM TO DO GAS FTITING (Type or print) Date 7--.26-06 NORTH ANDOVER,MASSACHUSETTS Building Locations S� 13yG1rL.,A-1 fQ Ue Permit# 10V,4/t/Sy/C" Amount$ 0��/d'� Owner's Name New® Renovation Replacement IKI Plans Submitted � W v� U .a W O x W a U Z z z w O F W ° W F� a ° o a 1G w W x x a W a W F W F C7 F z F z F. F y vOi °Ra Z O U F z W ai z a ¢ O O W M O W F o x W o 3 a U a U x > a SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6 T H . F L O O R 7TH . FLOOR 8TH . FLOOR *aL- (Print or type) Check one: Certificate Installing Company Name ,A19II i2 qni 19-1-Al Corp. Address /a'p, Partner. 4,4AII?10i✓l+G Business Telephone 97� G b s---9'S"� y Firm/Co. Name of Licensed Plumber or Gas Fitter 7`�/ooylA S 11411 g�✓ INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes In No If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity 13 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas yCode/and Chapter 142 of the General Laws. B Signature of Licensed Plumber Or Gas Fitter Yl Plumber of 11,F-7YTitle City/Town Gas Fitter License Number 0 Master APPROVED(OFFICE USE ONLY) R.71 Journeyman Location No. Date �oRTM TOWN OF NORTH ANDOVER 3 ° F41 w Certificate of Occupancy $ CHU <�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 07 a TOTAL $ Q*heck # 4 1 5 1 G 5 f�uilding Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DTE ISSN cly SIGNATURE: 1CZ Building Commissiede'r/I ctor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Pa cel Number Q� N 1.3 Zoning Information: 1.4 Property Dimensions: `n lie� --k- _..S.roQ Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide lteqtlired Provided Required Provided d FlZone Information: 5. Flood 1.7 Water Supply M.G.L.C.40. 54) 1. 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHWIAUTHORIZED AGENT 2.1 Owner of Record \ HanSur Dc( Wed 8uckLj10 Q Name(Print) Address for Service: \. ,,,� �&�/ i Signature Telephone Q 2.2 Owner of Record: �1 Name Print Address for Service: z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 0 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number M Address Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. r Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 'SV r - Completed b permit applicant 1. Building © � (a) Building Permit Fee Multi Tier 2 Electrical 3VL I (© A_A4 Q''e— (b) Estimated Total Cost of (� y . ►� ��1� Construction b V 3 Plumbing Building Permit fee(e) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Iq �'(.� ✓� Pa h D as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf in all m e s r lativ to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, A4Qian a U4 z OF1GL 0 Ul as Owner/Auth property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief PaTtSvr- I�GL&44 Print Name Signature of Owner/ t Date NO.OF STORIES SIZE BASEMENT O RD SIZE OF FLOOR TINIBERS 1 2 3 SPAN 161, DIN ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS 10 SIZE OF FOOTING ib" k 0 X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE '• - FORM U - LOT REL ASE FORM a �r i INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve f the applicant anal/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT M c,k 5L 00- 40 PHONE�7,' aq LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOTS 1 I STREETAuc_kLJt4 Mg ST. NUMBER *****************************************OFFICIAL USE 0 N LY*********************************** RECO ENDATINS � T OWN AGENTS: CONS RVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS ./ J P_J-� 0.n�e_ t00' NO � TOWN PLANNER DATE APPROVED DATE REJECTED t COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS C> v PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm �ftsbire�uT �'� 58.0$' ,,, sig 4 , 7 ss' �-Cr - /�og.D S A1EPEffY CeA75/fy TO Tye T/TLE/,(/SU.POrP.4,t/O - /�L O T PL A.-V Tl7 Tf/E B�4N,r TygT T,yEOwElL/.ctt/S LOCATED ON r�S/EG07',1s.s svir-. AA1,o T.yATrr-oa�s co.�1FGiP�ri' /N 1Y/7'// 7.s/E �"aw^�' O�/fit?, A/VDovae 20N/.vG .CE6vLATitJ,f/.S' � � 6vI.P0/.ifs SETdG/fit'.S'FEOit!STREETS GOT L/.vES." /�/Q . �upU v� �AJ S V =F!/,�Ti3/E,C cE,CT/FY THi/T TiY/„S OA✓E(1/NB /S�t/13T� L04474W/W T.yE FEOE.P.oG Fi[000 ffgZAt•O A?E,4. O,P•9lf�N FO,P S�JOIVA!Oi(/iEM,.f'COMMt/iviTy P�/�/CL '� oA E v a y F�n�ij i /� 6 SE.Pf�/C'ES t� v� 66 f34.P,� ST�EE"T .4,VODYE.0 �J,4S,S.4C,f/l/SETTS O/8/O Building Department '_ Ya ° O �< 27 Charles Street North Andover, Massachusetts 01845 - ' (978) 688-9545 Fax. (978) 688-9542 y, 14 I r DEBRIS DISPOSAL FORM In accordance with the provisions ofMGL c 40 s 54, and.a condition of Building permit-# the debris resulting from the work shall.be of in a properly Licensed solid waste disposal facility as defined by disposed MGL c 1 I, s j Spa_ The debris will be disposed of in/at: Facility location Signature of Applicant q-ZI - OI -------------t Date NOTE: A demolition permit from the Town of No Andover must be obtained for project through the Office of the Building Inspector. this i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: pot 110 d Location: LL c- t K al e— �' d oQ� veam a hoer performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address Ci Phone#: Insurance Co. Poli # Compan r name: Address City: Phone# Insurance Co. POUML_ Failure to secure coverage as required under Section 25A or MGL 152 can lead to the i and/or one years'imprisonment as well as civilSTOP tnposition of criminal penalties of a fine up to me. I.00 understand that a copy of this statement may beforw forwarded o the Office of Innvestigationss of the DIA for coverage veR and a fine Of rification. against me. I I do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature_ Date Print name MA A)W D Iq FU,T) Phone# 7� 68q 788"3 Official use only do not write in this area to be completed by city or town official' ❑Check if immediate response is required Building Dept E] Building Dept [J Licensing Board Contact person: [] Selectman's Office Phone#: Health Department ❑ Other FORM WORKMAN'S COMPENSATION 9 20 . 0 MANSvtL `DAHd'D # 212o '. ENERGY CONSERVATION APPLICATION'FORM FOR LOW-RISE I,IrSIDENTIAL NEW CO]"1STRUCTI:ON ApplicantAe Site Address:' P �UG1e1-IfJ •kbA`b Applicant Address: - City/Town: _N0, AN b g V C M ( Ars, Use Group: REST�C urs (ARA r f; 1,00/64 Date of App?ication:.' 1 Applicant Phone: Applicant Signature: Compliance Path(check one): 14 Prescriptive Package (Limited to 1-0'i•2-family wood frame buildinbs heated with fossil fuels only) ' Package(A through KK): 1HC sting Degree Days Base 65 ('HDD,j) from Table J5.2.1 a: (For items d,through i., fill in all values that apply from Table J5.2.1 b:) a. Gross.Wall Area J s f. Wall R-value R. . b. Glazing R.O.Area ----.7S_aq.ft. g.' Floor R-value R. [. c:'Glazing%(loo x b+a) !i; h. Bascmeni'1wa11 R- -- d. Glazing U-value U- '33 i. Slab Perin-;,,ter R_ c. ceiling R-value L-2 0 j. Heating A.x UE 85 Con Poncnt Performance: "Manual Tradc-Orr, (Limited to wood t+r metal framed buildinbs only) Climate Zone(from Figure J6.2.2) Zone 12 'Of Zone 13 [] Zone 14 —"-Attach-Trade�0ff Worksheet from-Appendi�,J;[and HV�ICTrade-Offif applicable)•-•----..- CJ jlfASchcck Software Attach Compliance Report and Inspection Chr.. klist printouts' Systezns`Analysis OR (].' Renewable Encrgy Sources . ,Y ...:.r q.i".....r.ti:.. ... .. Attach Mass Registered Architect or Enginc cr Analysis ' Official 's Name.: ' s Signature na tt:re Offi ciat, • . Application Approved =+ Date of Approval: application Dcnied Date of Denial: f Rea oiis :for Denial: (provide more details, if necdec, on opposi-c.side ,,, Bolts ov-_�),. 78?CMR Appendix J QuuderNamo Manual Trade-c)f f Works hcc,�; Bulkier Address SItB A�d�QSS � Dald,; Per mit u Submitted By ZoChecked By ne(]Iz '•X13 014 -=-- Phone . . Date Ceill_'n��s l; hfs and Floors Over outslr° .e Air ;• �, � Description Insulation R-Value x Nei i ,i Required Ceiling U•Valua' Area ' U-Value (Table 16.2.2a) 0 .O3 tt��• pp f I ■ UA r (Table J6.2.2) x Area Floor Ove-r Outside Air `r' 2$c� -_. 'o�0 ' UA . (Table J6.2,2a rt �� 't•. z 8`8 101 :0 . n ' Total Area t Walls Windows' and Doors Z88 it 1 Descripllon Insulation Walls R-Value U-Valu9.; x Nc� (Table 16.7.2b; Area =UA Required c,d) 13 9 n U-Value xArea Windows. .0 1o.'f f ■ UA (NFRv,'or7ab1eJ1,5.3a) DOors., : 3 73 h7—� X20 3G1 ,z (NFRC or TableJ1,5.3b Z'�'�'•° Sliding Glass Doors �~ (NFRD �--'• or TableJi,5.3a " f FIo Total Area. 2 b ft .. . ors ar.d Foundations ± - ---------- D Insulation Insulation Insulallon 'if"loCver'Un'. Depth, R-Value' t, • xArca or "p ,:. conditioned (Table Value Perimeter ■ UA ,' Required a U-Value 3asemcnt Wall J6.2.2e) I q ` �7 288 h , x Area = UA 047 (Table.. JnheateeSlab : J6.2.20 ft Table X.;2 icated SIaS In, ' ft able e 6.2.2 ) in• ItT. 11 _Toth/p�oPosodUAmustboless _. �' ' ' ;than rir o.,qual to robl Roqulrad UATotal •' (I: statement of Com Bance; �'roPosed UA I ----. Total p The proposed building detilan represented In thew documents li consistent Requlred UA peGfications.and other calculations cubm}tted with�J a Permk app(►oalion. t with the building plans. V1 l wilder esipner c� Iz CN-, - T" . p Y 9 zo a•� D • al e WRAF 1' (tor training purposes) 53 AORTH E ovm Of And o 0 Co'r,;,� �\,t dover, Mass., 0RATED 77 n 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.........At4/0.J.v..(.........DO./?.Q.W........................................................I.................... Foundation has permission to erect.../a.. a.q........... buildings on ..... 1......13...o c- /��r-u...../......c/....................... Rough t0 be Occupied as....02....bfo�j.....I..:.'^d4 bOV Ar Gia PAZ q a.P&V o rs Abo�y'� Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. a� 3 8 8 . PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det. i c) c Zd i�/OE'O.CivF.uA�/ �.� s� • _ sa.o8' EMEAI T 0 � ` �i FO✓.vo,a � �Lo �.. ,eogD 5� 6ck, is )oti Irl ins 1,o MAX. Oe, k� 35` Gvi`l �e- I-e- ul ed lo 51-elo kick pro®o6' D `roruia V_ 95 S,,+ba�((s F�n.�t- �D rays e ,� i ©nol,ed- /hee4 5./,6,4c:� X 11"456Y cE,cT1,9Y ro 7,416-TiT�E/,vsaeo c.4VoT �L Q� 'VT1"e W'f/lr TygT THEOwEGGictt/S LOe,4TEO OAA T//EGo7".�S S�/Y.t�ANO Ti�/.4T?OAFS CO,dFGtP�/ /N ,Y/TN n1w, �"aw^�' O/�/% .*voovf,e zommlG ,�6v/.PO/.tRs JETB.Ift'.S'FEOA1 ST.PEETS�fDT U�✓ES."' `yp . ivvav vG�� �AJ S S FIi.�Yy fE.�T/FY r~,-TAY/S 0.�2rLl/N6 /S NaT LO447E0/i{/ T3s�E FEGfE.P,4G FiCO100 HAT�4.�0 APE.4. DiP/��✓/v fOiP SiHOiVN 4/V i'EM.?• COMMVNiTy P.LNGL '� �� • �SOO98 DGS C . �`7'/�c.SiOE �AGrY �o.�� VIe .yL4 w' •RG.$$ OA E �gG''F'ss��t�,,�� /tIE.P.P/rtl.9Gt'�.Ii6.WEE.P�.v6 SE.P/�/lES A.t/OOYE.C, �1.4S.sgC.f!l/SETT.S O/8/O j c �j 1� oZUv �4- - 1 r 000 14 , Owl 3_S _ t W Location No, Date M°"T" TOWN OF NORTH ANDOVER ' of ,.• ..�a° 3? a °L Q Certificate of Occupancy $ _ Building/Frame Permit Fee $ ; _ Ss�cMusE Foundation Permit Fee $ a N Other Permit Fee $ ' Sewer Connection Fee $ Water Connection Fee $ �. TOTAL $ a N _ Building Inspector ` 8662 Div. Public Works ,�,,:...��, ,v-.-Y.-. _...�:.-.. .,wawa--�r;,..�,<.-•-n� w_.....�,..�._,Y�.r�u,.:,,,,,��,�'ak.i�'.s,3"�rw"','. Lscation 10D Date t - "°or TOWN OF NORTH ANDOVERs p Certificate of Occupancy $ •. Building/Frame Permit Fee $ a ''�s' uESQ Foundation Permit Fee $ s�cMs Other Permit Fee $ s� Qat. Sewer Connection Fee $ /'/��• i 1 Water Connection Fee $ 16, 54b TOTAL $ 7CU uil Ins cto � 3r t fit Div-A I Works d` . ..'atllAyh'_�_� �'4,�Yr.L ji"i'„iL'HT"+�„�Y�"'+id>Kynar? 'IM.`"I�Yy��'�'�KMW : .v.,Y'➢ YfA'.a� '. Location U) s w No. Date 2 �T�r "°oT TOWN OF NORTH ANDOVER 0. p Certificate of Occupancy $ s. Building/Frame Permit Fee $ , ss�cHuse Foundation Permit Fee $ ; Other Permit Fee $ ' Sewer Connection Fee $ $ Water Connection Fee $ :s TOTAL $ S� --..••� ' 1910 Building Inspector a k `J2 8661 Div. Public Works -17 PEWMIT NO. 4� ` APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP iJO. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE — ZONE 1 SUB DIV. LOT NO. ! �� t �s LOCATION 5-t if kc kp� d PURPOSE OF BUILDING S y` /e 1' l 14CA OWNER'S NAME // 'fysr NO. OF STORIES 2 1 SIZE 7_;3� .� OWNER'S ADDRESS 3 BASEMENT OR SLAB '',Q%B�c -2222 g� �✓ G G�Ly A*CI41TECT'S NAME C r �� SIZE OF FLOOR TIMBERS IST a�!a 2ND ���6 3RD BUILDER'S NAME ^"M� SPAN /-/ -- [ DISTANCE TO NEAREST BUILDING ® Q DIMENSIONS OF SILLS N x� DISTANCE FROM STREET - 2,o POSTS / DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT P"1..mac, FRONTAGE 7,6- HEIGHT OF FOUNDATION Q� "''r THICKNESS Yf IS BUILDING NEW ••! �® Y-110-5 SIZE OF FOOTING f�yO�22 % T IS BUILDING ADDITION 1^0 MATERIAL OF CHIMNEY IS BUILDING ALTERATION K C7 IS BUILDING ON SOLI OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Ye 5 IS BUILDING CONNECTED TO TOWN WATER � S Y j BOARD OF APPEALS ACTION. IF ANY •/1 IS BUILDING CONNECTED TO TOWN SEWER ��/ IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3� x PROPERTY INFORMATION SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY LAND COST 2,c> 060 EST. BLDG. COST V",1 PAGE 1 FILL OUT SECTIONS 1 3 REGULATED BY PARA. 114.8.& B.C. EST. BLDG. COST PER SQ. FT. �/- PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM ©® DATE FEE PAID SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 063 SUILDING INSPECTOR SIGNATURE OF OW4R OR AUTHORIZED AGENT F E E OWNER TEL.1< `v 7 1(44 �® PERMIT FOR FRAME/BUILDING PERMIT GRANTED CONTR.TEL.N r I9 ATE: FEE PAID-.-46% CONTR.LIC.It. 0 w 2, H.I.C.# r � } f X 2 31995 i _ $3�-t- i� BUILDING RECORD 1 ,.OCCUPANCY 12 - SINGLE FAMILY., SI-OkIES J1-16. THIS SECTION MUSTSHOW EXACT DIMENSIONSOF.LOT.AN�D DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMETVSI.ONS OF BUILDINGS. WITH. PORCHES. GA APARTMENTS RAGES. ETC. SUPERIMPOSED. THI,S,REPLACES.PLOT.PLAN. r CQNSTR'UCTION `_ ^_ r - \ r t -'•' 2 FOUNDATION 8 INTERIOR FINISH CONCRETE +�I B 1 • 2.:I3, CONCRETE BL K. IPINEBRICK OR STONE PINEHARDW D ———— PIERS PLASTER __ -• _ DRY WALL UNFIN. 3 BASEMENT I ' AREA FULL • FIN. B'M'T AREA _ - '/, 1/7 1/ FIN. ATTIC AREA NO B MT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 'q% FLOORS CLAPBOARDS B 1 23 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW D _ ASBESTOS SIDING — COMMGN —�— VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME...- BRICK ON MASONRY ATTISTRS. & FLOOR BRICK ON FRAME',-- CONC. OR CINDER BLK. STONE OTJ MASONRY', WIRING STONE ON FRAME SUPERIORPOOR _ -- r +H� ��� �-� ���•�� ADEQUATE I--i NONE s 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2-FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK- -• SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR i _TILE DADO z 6 FRAMING ; I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS: &COLS. STEAM STEEL BMS.`& COLS. _ HOT W'T'R OR VAPOR - IkI _ WOOD RAFTERS { AIR CONDITIONING RADIANT H'T'G S UNIT HEATERS GAS 7 NO. OF ROOMS OIL BMT 12.dELECTRIC Rom 3d Ist r NO HEATING ORT own of NoA . . oft 289 t _, --' �,: rt, dover, Mass.,�.5 uH& '1 19c S o �. �J COCMIC...CK ORATED '9 E BOARD OF HEALTH Food/Kitchen E R, M I T Septic System ., BUILDING INSPECTOR • .. THIS CERTIFIES THAT 4t" , !„� ....aae...................................................... ...................... oundatio has ....to erect... .�IYU-bulldings on ...�1....� k......ti ..r... .......... �- '• +•• �� Rough ^^••r,�� Chimney to be occupied as.2alaccepiing'61s-��%er t. ,.... ?!!� 1�.4JJP l 'A1 ... p 1...CAL....4Af?��...---'........................... it shall in eve res ebtconform to the terms of the application on file Inprovided that the severy P Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection Alteration and Construction o Buildings In the Town of North Andover. PtRMIT FOR FOUNDATION ONI. PLUMBING INSPECTOR REGULATED BY PARA. 114.8•S. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough _=E� FEE PAID Final PERMIT EXPIRE 6 MOIN ELECTRICAL INSPECTOR UNLESS CONS9T - Rough ....... ..... .... ...... .................... Service BUILDING SPECTOR Final a��`�� Occupancy Permit Required to Occupy Building ,�R s INSPECTOR o h �QA t Display in a Conspicuous Place on the Premises — Do Not Remove � %^ No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. ' Burner PLANNING FINAL CONSERVATION FINAL street No. j Smoke Det. I SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT Q?/w Q v�fJ r i l • � ��'P Mg. ��JYS��� I 14 1 . I I t FORM U - IAT Rt LE= FpgM v INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** � / A / PPLICANT: SI � Ave,Z Co r)'-*7 Phone LOCATION: A_sSessor' s Map Number Parcel Subdivision Ae'440011&1 7 Lots) Street St. Nu.-mer Use Only*******************W**** RECOMM.ENDAT ONS OF T WN GENTS: Date Anerove- Conserr:at-on ad::inistrator Date Rejected cc=en'. -� Date Approved Town Planner Date Rejected Co=er.:s Date Approved Fcod Inspector- ealth Date Rejected Date Ap-rcved Selz-c ins=ec,..._-Hem-t:: Date Rejected Coa:..:.er.t_ Pu-t-ic Wcr�:s - sewer/water connections . - driveway per-lit Fire Department R ceI ,red "by Building Inspector Date X 2 31995 s ZO�GdipE O.tivE.VA�S\ 6.QSE�I►9E='.UT __ 5'"8.08/ ., 'I��� / Fa✓tioAr7on/, � G 0,40 ".Z .4/EREBY IE.cT/FY rO 7We r/T(_E/,vSU,eo c.�v0 - PL.. o/ A,V T17 7ilE B.4�S/.t'TNgT THE�irECG/.btt/S LUCATEO O.c/ T//EGa7'.!S..s.5n�►-a,4.vo T,�,Gvrrroa�s codFctP.r1 �j(/ IY/T// Tf1E >ON'^/ OF/.,th, 9/V,00 we zON/NG CE6!/LATif9.t/S / / /� �6rI.Q0/.�i"s SETBAC.CS F•eOM STREETS�GDT U.vES."' ��/4 . /vvr�p vc� �AJ S s F!/.�TNC.t GE,PT/FY T�ViIT TN/.S OM'EGL/N6 /.s'NOT LOG4TEo/N THE FEGtE.eaG f;Caeo HAZ.4.�0 .4.PE.4. O.P.9�✓/V fO�P SAfd&VA1 OiS/FfM.4'COMMt/N/Ty/UAleG '50098 OG€�1G C /`i'/LL.3i0E" �AGTY �O.�P, Ak►4A�l�A1g3 dAT�l� 41-03 M.4 U r1t�i."sir'! -1i o urAV 6 A.t/OOi/ ,C ASS E , �1 .4lf�l/SE7TS O/B/O y Town of ' over No. 28 dover, Mass., Jume 2.7 19`tS_ LAKE T C0CHICHEwiCK { 7� ADRATED p'Pa\ �J E BOARD OF HEALTH Food/Kitchen PERMIT T Septic System I, BUILDING INSPECTOR THIS CERTIFIES THAT LAS.I.0E--'7QS 04� ..... q...... .... . . ................................................... Foundation has permission to erect......r- MME buildings on ...1S.1 ......r.�. .......... . o� s �a— Chimne l V to be occupied as.� . Mfl!1�J... .....D.41JA`111 .....�....�...�.2,....�>��..-.-�"........................... y cce tin this er it shall In eve res eCt conform to the terms of the application on file in provided that the persoh a p g p rN p Fina q, this office, and to the provisions of the Codes and By-Laws relating to the Inspection Alteration and Construction �f PtRMIT FOR FOUNDATION ONLY Buildings In the Town of North Andover. PLUMBING INSPECTqA j REGULATED BY PARA. 114.8-S. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. ou e , Z�.�( DM�ejz-114r- FEE PAID t� �t 3s • i PERMIT EXPIRE =IN 6 MON ELEC ICAL INSPECTOR i UNLESS CONST Rough 6-46`-s-3` ole, PER FOR MME/BUILDING ...)..... ... ... Service 16 . ...........r.... . ... BUILDING SPECTOR E ta; J-1 -21�% FEE PAID...._.... Occupancy Permit Required to Occupy Building GAS INSPECTOR i Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P 610A h , No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT / Burner PLANNING FINAL CONSERVATION Smoke AS A�►fir'} �' Street No. Sp,, ,w/ _ Smoke Det.,&. SEWER/WATER �) L") FINAL DRIVEWAY ENTRY PERMIT � CERTIFICATE OF USE & OCCUPANCY Town of North Andover � } ` Building Permit Number �� ' Z8 Date r fi THIS CERTIFIES THAT ifTHE BUILDING LOCATED ON `'BuG1Gl.ttj VD MAY BE OCCUPIED AS111k— '(Y1lLU IN ACCORDANCE tA/ CA e- 6-4RA16E WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. pORTq �+o. .•.,�. +tio s CERTIFICATE ISSUED TO ADDRESS � . CHO ?d n C • t ' t ' a F I 4 Ill t t O September 28, 1995 Mr. Bob Nicetta Building Inspector Town of North Andover Main St. N. Andover, MA 01845 RE: Lot 2, Meadowood III Dear Mr. Nicetta, This letter is to inform you that Hillside Realty Corp. will be tearing off the existing chimney chase on lot 2 at Meadowood, Phase 3 and will be replaced with a gas fireplace. This change is being done in order to conform with the lot lines. "K3 O o\c S\^L �r Regards, OXmes Demetri, for Hillside Realty Corp. cc: Levy, R. Phillips, M. 8� rs - 7dv Q� T� ^rY.2 4K Vd /y►-� co.m ��`°� tc file: \lot2mw3.wps Date.. .. . . . . ,�ORTry °f ,ao ,°,4, - o? �` TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION �9SSHCMUSEt This certifies that . /.s'�. . . . . . . . has permission for gas installation . .f'. . .. F . in the buildings of . . d�� �: : at . ! . ?3.t-. . . . . . . . . . North Andover, Mass. Fee.-).' . . : . . Lic. No..3:. .: . . . . . . . . .: rI . . . . . . GASINSPECTOR Check# / t 5—) ? E 4025 MASSACHUSETTS UNN ORM APPUCATON FOR PERAW TO DO GAS FITTING (Type or print) Patevce� ul-L NORTH ANDOVER,MASSACHUSET"I'S Building Locations - I ���1 u `�.CZ{�rtl Permit# (OL AA 11 n Amount$ Owner's Name �r i New Renovation ❑ Replacement ❑ Plans Submitted ❑ d H N z o 0 a 0 H o SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR - 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or / / J - one: Certificate stalling Company Name [Q�d'1 C Corp. Address 9/ ❑ Partner. Business Telephone — fj J/ ❑ Finn/Co. Name of Licensed Plumber or Gas Fitter /C e >-LC( INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes,please'ndicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus State Gas o e an Chapter 142 of the General Laws. 7 By. Sign re of Licensed Plumber Or Gas Fitter Title Plumber LO City/Town ® Gas Fitter License Number ® Master APPROVED(OFFICE USE ONLY) ❑ Journeyman 3� 35 Date..4, "1C"oZ-- NORTH °fTOWN OF NORTH ANDOVER OL PERMIT FOR WIRING �SScHUS This certifies that .....�� !7 ./� / ............................................................................... has permission to perform ..... /,......�-f:..............�. .............................................. wiring in the building of....f...�.�' -1c .............................................. at... ....... . ...`•,.. ' ..../ ..... ,North Andover,Mass. Fee..`/ .....`....... Lic.No.............. 4L ............................................ --ELECTRICAL INSPECTOR Check # Official UseaO,�nlly-' Permit No. � w ar�auct°L Si Occupancy&Fee Checked r?/% BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date % °- 1('0--o To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number J i V�J r Owner or Tenant k Owner's Address Is this permit in conjunction wJithh a building permit Yes [e No ❑ (Check Appropriate Box) Purpose of BuildinUtility Authorization No. Existing Service2o>J Amps Voits Overhead ❑ Undgmd $l. No.of Meters V 11 New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity i Location and Nature of Proposed Electrical Work.,rA�c,r A S'L'Y O O✓ i Total `14o.of Li htin Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting do.of Rece tacles Outlets r No.of Oil Burners Battery Units `r No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.,of Detection and No.of Ranges No of Air Cond l Tons 107— Initiating Devices Heat Total Total No.of Di sal No. PUMPS Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Spa a Heatin KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of D rs Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INS URANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = .(Please Specify) ( P iration Date) ' Estimated Value Electrical Work$ Work to Start I S-6 Inspection Date Resquested Rough Final Signed under1hp Pen of perjury: ff FIRM NAME, A..1 au% L to 'L LIC.NO. LY ��// f�,�� ��a 5"a Licensee %�e \ Signature LIC.NO. �7 \ ` `` Bus.Tel No. Address_O(o r l�r, C h n Q J t4 w. I�r'1 030"7 jp Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requlrement. Owner Agent (Please Check one) i1 Telephone No. PERMiiTfEE $ (Signature of Owner or Agent) BUILDING PERMIT of Na oT"pro TOWN OF NORTH ANDOVER oa '6 O APPLICATION FOR PLAN EXAMINATION ' = n t 4� e Permit No#. Date Received " ��SSgcHus���y Date Issued: �� IMPORTANT: Applicant must complete all items on this page 73 4 . .,' Din Yom. t� a : fPROPERT�Y",OW-NE�' I`�.G. 1.5y!rB! _Q.ho� PnntUCt ` �Y�22fiJtfUfe ,y2�S n0 F#'MAP � ; PARCEL _ aZONIN�G �DISTR CTS, --4Histric D'str�Sir RG o - -,--�--�7s ` AN 00 TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑ New Building ne family ❑Addition. ❑ Two or more family ❑ Industrial ❑A ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ." ". .s.h "Hr LY'r.-t?-%."� "' x k 'yl^ ."' 'ar - 1 -,.: i`--' '.Nt Y w'rs��T^..,ae :" -^--'F -u,� ^sat 7k O£S optic. O Well x '�* ❑1Floodplam f i s❑Wetlands , . ❑ Watershed Distract ry ` ater/Sewers .4.# DESCIRIPTION OF WORK TO BE PERFORMED: � �✓— a r- C.t rd d Y, Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: } �Contractor�Narne�,�ir1�. dKs,Phone �� 7 .�.� r� �;,$�73� ^1�t2 ,, 2 ' a . mss ' .... `'."'.p"5Ar#-- "g'�`§' t r, r �. ESsAa xm.a 7 � ` s ,Adtlre�SS � to / . � � �V 3 h Fg'r z '` * SupervsorConstructionL�cense GSF�°r a:y �SG 7� Exp ate.R 11.x' %5 _ , 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.: �- 9s, ��-r-"V� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to he guaraAty fund Signature of Agent/Own'er ;x .`%%t � � ;Signature of contractor' Location i/ r� No. Date r i t • TOWN OF NORTH ANDOVER Mb ` Certificate of Occupancy $ Building/Frame Permit Fee $ , Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# la a 21 Building Inspector I i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiumning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on 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 Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE% EPARTMENT Tem�T ff e3n.« w^"a'' A a. `t+`i,.`Y''3",}. :" '�+"°5. " �— -.-*t9 a m s^-: „ r p Durnpster onksite�yes� no�i N. a L�ocatetl�at1WAR 24Me n Street= ' 3xF,ire Qp j 4— artmentTsr nature/date Fy 9t rs � & massa s iB 33 ' C®IVIMENTSs ' 3 z" r 3' saa Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc-Building Pen-nit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits a Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations y (If Applicable) o Mass check Energy Compliance Report (If Applicable o Engineering g g Affldavlts for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan o 'Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 � �"//ze Yprynrmu»ausea�a��aa�ac/u�ve�a Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 173076 Type: a> xp iration: 8t32Q6 Corporation LYONS DEVELOPMENfi-CDRP-- JAMES LYONS 261 HYATT AVE BRADFORD,MA 01835 Undersecretary Massachusetts -Department of Public Safety ' Board of Building Regulations and g Standards Construction Superv,isor.,l &c 2 Family License: CSFA-047567 JAMES H LYONS 261 Hyatt Avenue,' � j�� Haverhill MA 01035 ✓.�.• " 141 Expiration Commissioner 11/07/2015 The Commonwealth of.MMassach.aseft - Department of lndustrigl.Accidents . , Office offivelsfigaflons 600 Washington Street Roston,MA 02111 v w mass govldla workers'compensation bsuxaxace Affidavit:Ravens/Cont°actor/Eleetreician-s/PI*bex.0 AnUll[cant orrna on Please Print Log—My NaMa(Businoss/0rganization&di.viduai}: {—.4 ti r�, _ J wt. �r Address: o3 —Phone#: 32R0,462-- Jy 7 CiYIStafe/ pr ,Are you an employer?Check the appropriate box: Type of project(required): 4• []x am a general.contractor and T 1.Q T am a employer with________� 6. [l b7ew constr<zction employees(Mandlorpart time)* have hired the sub-contractors 2.❑ I am a sole proprietor or paztnex listed on the attached sheet I. �(R Remodeling ship and`havena•employees These sols-contractorshave S. [])Demolition worlang forme in any capacity. workers'comp,insurance, 9. El Building addition INo workers'comp.insurance 5. We are a corporation and its 10.0 Electrical repairs or additions regaked.] officers have exercised.their 3.El am homeowner doing all wont right of exemption.perMOL 11,.[(Plumbingrepairs or additions myself LNOworkers'oomp. c.152,§l(4),andwe7�aveno 12.Q E-oofxepairs insurancerequixed.� employees.[No workers' 13.[]Other comp.insurance required.] Any applicantthat checks boxg mustalso fill outthe section below sho-wingtheir workers'eompensationpolicy information. i-Homeowners who submitthis affidavit indicafingthey ko doing atlworlc and then hire outside contractors must submit a neve affidavit indicating such, TContractorsthatchecktbisba must attached an.additionalsheetshowingthename ofthesub-contractorsandtheirworkers'comp.policyinformation. lam an employer that is•providing•wo�kM'compensation insurane fo�'rr�y employees. Below asthepolicy ancijob site in,formation. • insurance Company Name' Policy#or Selz ins. ic.#: EXPiratlort Date: lob Site Address, CitylState/Zip: -A.fEach a copy ofteworhers'compensationliolxcy declaration gage(sbowing•the policy number and expiration date). Failure to secure coverage as requixecdunder Section 25A.ofMOL o.152 can lead to the impositim of es of a flue up to$1,500.00 andlox one"year imprisonment,as well.as civilpenalties in the form.ofa STOP WORD ORDER.and a fine of up to$250.00 a day againstthe violator. Be advised that:a copy ofthis stateimr.entmaybe,foxwardedto the Office of: Investigations of:the DTA.for insurance coverage verification. andpenalties of perjury tlica the informatoDn avtTeo:vileci a7 ve ue and eorreet,dolierebye77Zunle iia gins 7 1 are. I'lnone#: official apse ortly. .DO not write in this area,to be completed by city or town official. City or:Town: Permit/License 0 Issmng.Authority(circle bne): 1.Board of Health.2.BuildingDepartment I CityRown Clerk 4.Electrical Inspector a.Plumabbag 1aspector,, 6.Other _ _ _ Information and Ius�°uctxons Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for them employees. Pursuant to this statute,an argployee is defuted as",..every person E the service of another under any contract ofhire; express or•implied,oral orwxitten." An.eraTlaydis defined as"an individual,partnership,association,corporation or other legal entity,or any two o moxe ofthe foregoing engaged in a joint enterprise,and includingthe legal representatives ofa:deceased employer,.or the receiver o trustee of an individual,partnership,association or other legal entity,employing empjoyees. owevex the owner of a dwelling house having notmore than three apartments and whoresides there4 ox the occupant ofthe dwelting b Ouse of another who employs persons to do maintenance,construction or repair work on such.dwelling house or onthe grounds ox building appurtenant thereto shallnot because of such employment be deemed to be an.employes." 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 constxxmet buildings in the commonwealth fox 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 ofpublie work until ecceptable evidence of compliance with the insurance requirements of Us chapter have bcenpresented to,thecontractingauthority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if iiecossaty,supply sub-contractor(s)narme(s),addresses)andphonenumber(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than,the members oxpartaers,arenotrequiredto canyworkers'compensationinsurame. Tian-TIC orLLP doeshave employees,apolicy is required. Be advisedthattbis afOdavitmay be submitted-to theDepartment of industrial Accidents fox confJrmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should b e returmedto 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 kw or if you are requiredto obtain a workers' compensationpollcy,please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate lice. City or Town Of acials Please bo sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ofthe a�Mavitfor you to fill out in the event the Office of Tnvestigationshas to cont actyouxegardingthe applicant. Please be-suxe to f flintho permit/license number Whichwill be,used as a reference number, lh addition,m applicant thatmust submitmultiple permit/.Ucemo applications in any giv anyear,need only submit one affidavit indicating current policy information(ifnecessary)and under`'M Site Address"the applicant shouldwrite"all10G"Wdns im (city or tovrn)"A copy of the affidavit thathas been officially stamped or marked by the city ox town.may be provided to the applicant as praofthat avalid affWavit•is on: le�[or fiifnxepemrits orlicenses. .Anow affidavit must ba filled out each year.'Where a home owner or citizen is obtaining a license ox,pennit not related to any business or commercial venture (i.e.a dog license orliermit to burn leaves eta.)said person is NOT required to complete this affidavit. The Office of fn-vestigations would like to thank you in advance for your cooperation and shquld you have any questions, please do not hesitate to give us a call. The Department's address,telephone ahA faxnumber: c CA 9 w�aIthofMas aohv.:SPt Pepa tenti QXMu*1al AraddeatR Office QJURVestigatiolm 600 W lre�t TO,#617.72�4900 Q-406 ax 1-877,WSAFE _ Revised 5-26-OS 4 ' v4v.�t ,g4vfc.�a • NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN s ' RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business]NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: j--2-0 l Lp Buyer's Signature: Zl i �.�/C�' �t.-� � eit e• 1C1 f�i.C'..42%7 /`: A VC, J 0 Massachus(tts Home Improvement Sample Contract t.. This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL"chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the'' Office of Consumer'Affairs and Business Regulation's Consumer Information Hotline at 617973-8787 or 1-888-283-3757 or on our website. Homeowner Information F ' ' , Contractor Information t Name Company Name f Street Address(do not use a Post Office Box address) Contract /Salesperson/Owner Name G Ci yfrown State Zip Code Business Address(must include Ostrect address) Daytime Phone Evening Phone City] own State Zip Code,'' Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number Home Improvemem Contractor Reg.Number Expiration date Law requires that most home - Improvement contractors have /) avalid rrglsYrativn number .� "23 W !t The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) 1 I�C�ca t r G�4.7'e� �G..tn.0 �� I �J 6 a s-c int �.�.�" a peel` • r '• ,tl cQG/ i� tic jJ /_ 1 14 f C-� 1JGi;f"'II V-UUZ'1 CCL . NJ � ! ^ ►� y p Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure'their own permits will bet� ill ` excluded from the Guaranty Fund provisions of //S// / Date when contractor wbegin contracted work. f 1 MGL chapter 142A.) ' '' / G Date when contracted w rk Y cora o will be substantial] completed. s . P Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of c', 510c), 0 0 O +, Payments will be made,according to the following schedule: $ upon signing contract(not to exceed 1/3 of the tots" 6htract�price or the cost of special order items,whichever is greater) $ by _/ / or upon completion of $ by _/_/i or upon completion of r $ •, y �_ upon completion of the contract. (Law forbids demanding full payment until contract is completed to botli party's satisfaction) The following material/equipment must be special $ ' to be paid for rt ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for ' NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may` f not exceed the greater of.(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being provided by the contractors No Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement " r I - t• ! Contract Acceptance-Upon signing,this document becomes a binding contract under law.'Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. pressured into si i ' • Don't be r t'-•. p gning�the contract.Take time to read and fully understand it. Ask questions if something is unclear. _ • Make sure the contractor has a valid Home Improveiment'Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Imnrovement Contractor Registration. You may inquire about contractor Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by.the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,cha er 142A. Homeowner's Signature Co ractor's Sign re NOTICE: The signatures of the parties above apply only to the agreeme t of the parti o alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed-by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws (i.e. MGL chapter.93A)may not be waived in any way, even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted-work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 1 617-973-8787, 888-283-3757 or visit the OCABR website at http://,amv.mass.gov/ocabt-/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: I 1 NORTH Town of t E :. �� Andover 10 No. - o Doh ver, Mass, COC LA a MICN.WICK S V BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System THIS CERTIFIES THAT ............. ...... . . .................................................... ... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ..........f„a..�.......... .a. •. ,...... � Rough to be occupied as ...... ............ tom... �..............� ...... ......... ......... .�i �.. • Chimney provided that the person accep ng this permit shall in every respect conKm 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 CONSTRU�ZIONVARTS 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.