The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 51 HAY MEADOW ROAD 4/30/2018 (2) 51 HAY MEADOW ROAO 210/104.6-0098-0000.0 Date...I\A ................... oaf; oom TOWN OF NORTH ANDOVER PERMIT FOR WIRING 14U This certifies that cj�Atz L'Da PA A�15 ..................... ........................................................... has permission to perform .... ..........................-..... ....../Z............... ............................. . .... .... wiringin the building of.,:,,, .................................................................................... at ..................... Xo)rtb Andover,Mass. FCC' Lic.No.17-11.0 .............................. .... ......... .........H!Q ....... .......... . ....... ELECTRICA NSPECTOR Check# 20 VA be The Commonwealth of Massachusetts Office Use Only �• Department of Fire Services Permitq n BOARD OF FIRE PREVENTION REGULATIONS Occupancy&Fee Checked Rev.1/07 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code(MEC), 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: November 3,2014 City or Town of No.Andover,MA 01845-1405 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (street&Number) 51 Hay Meadow Road Owner or Tenant Ralph&Maureen Enos Tel. No. 978-682-7617 Owner's Address Same Is this permit in conjunction with a building permit: Yes FX I 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 .3 Location and Nature of Proposed Electrical Work 3 Season Room Completion of the following table may be waived by the Inspector of Wires. No.of Lighting Outlets No.of Hot Tubs No.of Transformers No.of Lighting Fixtures 7 Swimming Pool Generators No.of Receptacle Outlets 6 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switches 3 No.of Gas Burners FIRE ALARMS #of zones Nr,111f Ranges No.of Air Cond. Tons No.of Detection A. No.of Disposals No.of Heat Pumps kw No.of Alerting No.of Dishwashers Space/Area Heating kw No.of Self Contained No.of Dryers Heating Devices kw Local Municipal F-5 Other No.of Water Heaters No.of Signs Data Devices No.Of Hydro Massage Tubs No.of Motors Telephone Devices Other: 60 amp Sub Panel Attach additional detail if desired,or as required by the Inspector of Wires. r l v Estimated Value of Electrical Work: $3,000.00 (When required by municipal policy.) Work;o Start: Noyember4,2014 Inspections to be requested in accordance with MEC Rule 10,and upon completion. IN°(�;RANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation" coverage or its substantial equivalent.The undersigned certifies that such coverage is in force,and the exhibited proof of the same to the permit issuing office. CHECK ONE: INSURANCE F77 BONDF- OTHER F-(specify:) I certify,under the pains and penalties of perjury,that the information on this application is true&complete. FIRM NAME Dumais Electric LIC. NO. 12170A Licensee Mark A. Dumais Signature LIC. NO. 26665E (If applicable, enter"exempt"in the license number line.) Address 8NewportStreet Bus.Tel. No. 978-683-9438 Methuen,MA 01844 Alt.Tel No. 978-685-4553 *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 insurance covera a normally required by law. By my signature below, I herby waive this requirement.I am the(check one)F owner [)wner's agent Owner/Agent Signature Telephone No. IPERMITFEE: 1, �' CJ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street 1W Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Dumais Electric Inc. Address: 8 Newport Street City/State/Zip: Methuen, MA 01844 Phone k 978-683-9438 Are you an employer?Check the appropriate box: Type of project(required): 1.3 I am a employer with 9 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Travelers Policy#or Self-ins.Lic.#: IEUB-7C83307-8-14 Expiration Date: 2/2/15 Job Site Address: 51 Hay Meadwo Rd City/State/Zip: N Andover, MA 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. SiAno : —M. Q• Date: 11/3/14 Rhone#: 978-683-9438 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions - Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. 9 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax 9 617-727-7749 www.mass.gov/dia h c. Please visit our web site at http://www.mass.gov/dpi/boards/EL DUMAIS ELECTRIC INC MARK A DUMAIS (EL) 8 NEWPORT ST METHUEN MA o1844-3425 Fold,Then Detach Along All Perforations ..»-.. 1rOMMONWEALTH OF MA UCHUSETTS..1', BOARD OF EEGTRiCIANS 4 4' �> ISSUES THE..FOLLOWING L I,CENS'E AS A RE:6I$tRO lMASTER ELECT,R1"C1'AN�`✓<` D.UMAIS ELECTR IC .INC iVF D U A.I S A"R K "A M .. FIS 8 NEWPORT ST"" W i METHUEN MA 01844-3425 Y f J h 12170A X :07%31/16 r, 27306 Please visit our web site at http://www.mass.gov/dpi/boards/EL MARK A DUMAIS (EL) 8 NEWPORT ST METHUEN MA 01844-3425 j Fold,Then Detach Along All Perforations ; COMMONWEALTH OF MAS94Hl1SETTS;.r' • •)ma:1619 101 ,BOA D'OF E,L:,Ei k I C9 ANS v ISSUES_ THE FOLLOWING Q'I CEAE f s' AS,:AA<REO�JOURNEYMAN ,ELECTR.I I A x" MARK A D UMA 15 r \�L 8 NEWPOtT -.97 HuEN ,MA 01844-3425' 266651") x.:y° 01/31/16x; T'27301 x Date...�.;....s......�`.......... t � R pT.".'ti TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING This certifies that.!.,- `.C....:`.` � ....................................... x ..�. has permission to perform�) r . ..`Gz� .�..;.... Pat............. ...................buildings of............................... plumbing m the, uiis� � North Andover, Mass. Fee r. ...... ......Lic No. .`�.1. ' .. ....:....�. ...... PLUMBING INSPECTOR Check# �r �' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ ¢VGA, MA DATE [ PERMIT# JOBSITEADDRESSOWNER'SNAME --` POWNER ADDRESS 0 cl1 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL EQ RESIDENTIAL Q PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:Q PLANS SUBMITTED: YES E0 NOR FIXTURES'l FLOOR--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ( 1 � 1 i I t 1=== I CROSS CONNECTION DEVICE 1 _ _( _ _) _ 1 ,._._E E -._ +t �, @ 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN I i i ( _____1 -_ t ____.--I ---_._ I -- .-__._...J ...__.... ► -_ .__ __...._J _,_( ...._._1 FOOD DISPOSER _ _� _..I _._.-._.- ---___( w f I .__.._1 ( 1 __..._-I .._-,_.-_t FLOOR/AREA DRAIN _1 1 t _._ I _-.___ ___.-1 INTERCEPTOR(INTERIOR) _I I . I t ..__._ ( -._-i _._.i ____j ___.__._1 __.__I ._._.__t KITCHEN SINK I _J 1 .._� � J � i t I _.__.. f -__.j LAVATORY _---- ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION t ! ------ .___._._ _.___. __ I _ -.A _._�1 ._____I ._...._. ._t ___I WATER HEATER ALL TYPES t t .-___ i i WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO El IF Y61.1 CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW : LIABILITY INSURANCE POLICY t OTHER TYPE OF INDEMNITY Q BOND D 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 10 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accur to th est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' ce ' all e ' e ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMELICENSE# SIGNATURE IMP A— JP CORPORATION 0#=PARTNERSHIP�# _ _:LLC EQ#iJ COMPANY NAME �' fl-dADDRESS CITY I STATE ZIP ---- �J _ 11 TEL i FAX t CELL EMAIL PS /yI/✓S__s? ! ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL WSPECTIO NOTES Yes No d s THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of IndustrialAccWnts Office of Investigations 600 Washington Street Boston,MA. 02111 www.mass gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address:_ City/State/Zip: 41_ ,��r � Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and I 6. El New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. E]Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.E]Roofrepairs insurance ]ired.re q uemployees.[No workers' 13.1-i Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce and a pa' enalti s ofper. ry that the information provided/above is MY aul correct. Signatur . Date: ` Phone 2L 9-1 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: 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 he buildings in t commonwealth onwealth for an applicant who.has not roduced.acce table evidence y P v nce of co » P 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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho GoM140xlwoalth of Massachwetts Department ofladustdat Accidents Office o£Investigation s 600 Washingtoa Street Boston,MA 02111 TO,#617-727-4900 est 406 or 1-877rMASSAFE Revised 5-26-05 `ax,#617-727-7749 www.mass,goV/dxa r lri s•� t :&&9QMMONWEALTH OF MASSACHUSE,TTS,.<, << ,BOARD:'Q� PLUMBERS AND GASFlTERS I SSUE,S: THE FOLLOW 'L I CENS WI L I Cf;N5.E<D AS A J0URNE,:YMAN;-P--. gE RICHARD T BOWMAN s� r y , 6 H0RN1=.<.5.� ;, ,r• ,y z i • (+'inti-*.-�ri'� � I T : .BRADFORD..: :.:;,.:; MA 01835-802J ' 4 :. j I i r;:c >ICOMMONWEALTH OF MASSACHUSETTS:>:< - . :..:BOARD:.OF , PLUMBERS"'AND 6AS1 ITT ,RS # ISSUES ,THE FOLLOWY'NG""'L I CENSE ;.. 'i. LICSNSED AS A MASTER PLM i RICHARD T BOWMAN r j 6 HORNS ST.. �Lu RRADF0R35-80 p MA 018 �J 24 I f , -�7�S'u 9 0 Date. s.:3 t . .t. . NORTp ?��.��•.'.;•'+ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,"SA CNus This certifies that t(. 14 `. . . . . . . . . . . . has permission to perform . . ��"� '' J!!'. . �✓E<�.�vS1ti.� plumbing in the buildings of . RP, Petr,S. . . . . . . . . . . . . f' at. . . . . . 6 !jJ. ,dj . . . . . . . , Nort Andover, Mass. Fee.1.07:19.Lic. No..2.G.-a.Y� . . . . . . PLUMBING INSPE Check # 1 0V\_ r ASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING M(,�ly//P l/ r ` J MA. Date• Permit# l �j / �1/ jential[] �G�'`� Owners Name: ✓: Commercial❑ Educational❑ Industrial❑ Institutional Resieration:❑ Renovation: Replacement: ❑ Plans Submitted: Yes❑ FIXTURES DEDICATED N ? SYSTEMS 2 Z Lu Ny, O Z U O z d to z �' Z U N W ❑ O a` _ z a a lu m z z rz O °° En w Fw- N } Q N O a h0 N h w Fw- p 1 O Q Q Z cr tY I7 X a . F^ a '✓ Z w � D ❑ w z w Z v LLwOZ Lv a Of-= aQnt4OOF > OOa dTf O w Q Z Z N H F- w w Q m m A LL 2 Y O z 0O it Q Q Q z ❑ I Q } I- •Sus Bsnnr. o 3 3 u a Q BASEMENT 1sT FLOOR 2 N FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR !1St=11iti COii,r.&gA Iv�m• �� jjlj[L�►{ICJI ! It''C ri=Cm,r E✓l- 'i Addresso C jC Y� El�l City/To �� State Business Tel: G 3 7��a-�aFax. ElPartnership Name of Licensed Plumber: ( � �f� 1A� � irm/Company INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes o❑ If you have checked Yes,please indicate the-type of coverage by checking the appropriate box below. A liability insurance policy'E] Other type of indemnity E] Bond E] 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 >1CInature of Owner or Owner's A ent Owner El Agent ❑ � 1 hereby certify that all of the details and Information I have submitted(or enfered)regarding this application are true and accurate Knowledge and that all r�� (j O p. mb!ng work and Installations performed under the permit issued for this application will be in Compliance mplian a°w With all the bestcf my �04) Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 o;the General Laws. t n? + - Type of License: :te ❑Plumber ignature of License Plumber y/Town r❑,,M�sten 'PROVED(OFFICE USE ONLY) ud�ourneyman License Number: Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS%.' BOARD I IMPORTANT NOTICE PL LICENSED AS A JOURNEYMAN .PLUMBER: , PERMITS FOR PLUMBING AND GAS FITTING INSTALLATIONS ON STATE OWNED OR USED ISSUES THIS LICENSE TO FACILITIES MUST BE FILED AT THE OFFICE OF THE STATE BOARD. TYPE RICHARD COLMER -J 4: TAMARACK RD U) PLAINSTON NH 03078-0000 756575 20349 05/01/12 756575 L. LICENSE NO. EXPIRATION DATE SERIAL NO. Fold,Them Detach Along All Perforations - - - � 1 . r Location ea No. � Date AORTPI TOWN OF NORTH ANDOVER 0�� .a° ,•,tiO 3? � • OG Certificate of Occupancy $ �'�s •Eco' Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ Other Permit Fee $ r Fr- `� TOTAL $ ' Check # Z Z e off If Building Inspector- ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 3 .:,„{` 4"s r..1s3 l a'" ,:„ k€V ✓'{�j DATEBUILDING PERMT NUMBER: ic SIGNATURE: oDate d ZBuildmmssioner SECTION 1-SITE INFORMATION 1 O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: , HaIA rneckc-Aouo Rd . Map Number Parcel Number 1.3 Zoning Information: V► �(� V l 1.4 Property Dimensions: Zonin District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide Rapired. Provided R red Provided v 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 list � . u o m SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT -- 2.1 Owner of Record ih I Ia Print Address for Service:T I Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable iI Licensed Construction Supervisor: License Number Mn Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 ompany Name y� rn Registration Number r C eoj Adess Expiration Date P� Signature Telephone �i0 i SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) y Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.... No.......0 SECTION 5 Description of pr#posed Work check a0 a Hcable New Construction 0 Existing Building ❑ Repair(s) 0 Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition ❑- Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Of?]HC Ali:USE ONLY Completed by permit a licant I 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC / 5 Fire Protection /Q 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AU RIZA TION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,as Owner/Authorized Agent of subject property Hereby authorize to act on a My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION �L-f eS ,as Owner/Authorized Agent of subject property g J Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Prrn,t Na,�pte a Sig2ature/offOwner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of itAndover No. o z over, Mass., File V COCHICHEMCK SRATED P'PG �C) �i BOARD OF HEALTH PERM D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT..... ... ...... ....... ........... ...................:................................................. .�...................... ;Lundation has permission to erect........................................ buildings ono.7...... h t0 be occupied as....... Chimney provided that the person acceptin is permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions 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. trough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT'IO ` WAT 71x Rough ............ Service . ................................................................................................ BUILDING INSPECTOR Final Occupancy Permit Required to Occz4py Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. Department of Lndustnal Accidents Office of Investigations 600 Washington Street Boston, Massachusetts 02111 ` Workers' Compensation Insurance Affidavit Application Information Please PRINT Iegibly Name: Location: Citv: Phone#: ❑ I am a homeowner performing all work myself. ❑ 1 am a sole proprietor and have no one working in any capacity. am an emplooy��er,providing workek frs*compensation for my em wo employees ring on this job. Company name'L Jl✓ r1Q� I L L' , I r) - City. CU- ( Phone Insurance Company: Policy#- 0 ❑ I am a sole proprietor,general contractor.or homeowner(circle orte)and have hired the contractors listed below who have the following workers'compensation polices: Company name.- Address: ame:Address: City: Phone#: Insurance Company: Policy#: Company name: Address: City: Phone#: Insurance Company: Policy#: Attach additional sheets if necessary. Failure to secure coverage as required under Section 25A of hIGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 and or one years'imprisonment as well as civil Penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day rFainst me. I understand that a copy of this statement mar be forwarded to the Office of,1nvestigat ions of the DIA for coverage verification. i do hereby,eertify nder t/te pacts g(rd penalties of perjure•that the information provided above is tare aced correU_ Signature— Print Date: j U Print name:_ Cb dam- Phone: Official use only Do not write in this area to be completed by city or town official. City or town- - Permit/License# ❑ Building Department O Licensing Board ❑ Check if immediate response is required. ❑ Selectman's Office O Health Department Contact person: Telephone#: O Other (revised 3195 PJA) ACORD CERTIFICATE OF LIABILITY INSURANCE can pow "m OF 000MIAT" Bovo T; Inaurance AgoscV, ine- OILY AND CONIMM NO RK; M UPM TM CEMICATB HOL.OaI:R. THIS CBlTVWA"R DOE`A NOT ANEW. EXTEM OR 341 Trepelo Rd. ALTER THE COVERABE AFFORDED BY THE rOLMM8 B�VP1L Belsoat, Mk 02478 INSMAM AFFORDING COVE RAM MAIC s1eLlPea sw,aatA z>sauranoe Bupow1cr InduAtx-!", 2nC. sww a Associated Industries or l/eaa w 33 Great Rd. ssutpl c sang I"- 00. Shirley, mh 01464 NOLWO r THE POLICIE6 OF MMRMXE LIVED BELOW WIVE BEEN HUED TO THE PWX*a NMIED ABOVE FOR THE POLICY PERIOD M r TEM NOTMIMMM"G ANY REGURBAENT. TRW OR 40MOIn0ft OF MY COMMOCT Olt OD" OOMNAM WITH M PEC1 rO "4CH THM Cbn*10ATE MAY EW- ISSUED OR MAY PERTs IK TM VISURANCB WOF4MD BY THE POLXXS HOLM IS SUSBCT TO ALL THE TEFtM. EXCLUSIONS AO COMMM MS OF SUCH POUCIM AW.RE6ATY UNITS SHOWN MAY HAVE 14PLR RfD XM BY PAD CLANNB. wow AVVL LTR TVM OF i PO�TMM�[ DAIS OAT tmfq Se'RRAL 11ANILJIY EACH GMMMEMMi 3L,000,000, A X cmenw4m o9sAKwsmmr p temaegW�sy- s-- 100,000- c1ArlsMwoR vreare 41—I.7[—s>9D 112/17/04 12/17/05 mw or 4say wA pmkm) s excluded IeiSorwL A AM ISAJRY #1'000'000. await-1 Mara"" *2,000,000. QD&A=FC*ATrc UW APPUM PM- peDDLCIa-co~"c _- s2,000,000. paler J Lea A,rToroPP>s UAesiTT coMWED OP M L"T $1,006,000. AMYA TO ALL CVAdM ALMS POOLr DLRMY C E SCHMU.MAUMS 1347609 01/08/04 01/08/05 _ s DODLYMMY Mioe401MNlD AIfT06 rerdoddmq d Ferm�drrd) � _ dwUM&VAMMV A HOMY-6AACCCOff i AAum OTHM THAN FA 1 M• Auro Orin ASO f a�sArl�eLAlawln sAca+o�ocLA s ocuse �eeaPiPMu�o� AoeaeaATs s aElLcre4 s rors�seoraaMrorMin .. .'lom!Lsna 1>R H '"NretsanY AWC7011362012004 12/17/04 12/17/05 EL M CHACCOM S110001000. EgcLLorseW-MEMPLOYM s 11000,000. s"%dome.ruder OPECML movimcm ewer E1.019GAM,POIrCY u.T Is 1,000,000. oTMee AOd�C>td�WMOSAWaTsslMrio�ATt�MI�A�C►prdmewmodradf'rdrevrd.dRa�eodd . CER MATE HOLDM CANOE LLATMN 01mb AMY CW Im papa DsoCImma PGL® dE 402023LD mw5 m TIE ®wing+ OATS Tom. TIE AMPMP moa PAL DOEAYOQ TO ra 30 DAYS LrIMTI1DN MOM TO TIM CBIIr1CATE MOLa!!t MUM TT, TIE IST, EUI FALJ TD 00 PO WHI L �OOI MO GSL OXV M OR UIS11Y w AM via LMOM TM MYYW^ AMMM GO m�1MT'erBe. Avnso ED IIM11mE1fl14iIMe ACORD 26 19BR �i��0oaw�onu�salDE o�,/�Laasaa�srsell`s Board ofB.uild itAxNlations-and Standards HOMe..tM: O #RENT CONTRACTOR «: 4428 . 006 Corporation SUPERIOR INfl SEAN GREEN 33 GREAT s4kLEY,MA 61:464 - Admidiatrator . SUfP,,,.zn1 or MMMI INDUSTRIES INC. ROOFING GUTTERS RUBBER ROOFS Ralph Enos March 31,2005 51 Haymeadow Road North Andover,MA 01845 Cell: 508-587-6600 Eve: 978-682-7617 Roof Will Be Hand Nailed Only 1. Details of area to be completed: Entire House(excluding screen porch) 2. Remove existing layers of asphalt shingles and dispose of properly. 3. Completely de-nail roof and re-nail roofing boards as needed. 4. Replace any rotted or broken wood(roofing boards)at no cost up to 100 lineal feet of board or 100 square feet of plywood. (Additional lineal feet available at$3.50 per ft. and$1.85 per sq. ft.for'/2"plywood or $2.25 per sq.ft. for 5/8"plywood.) 5. Apply six feet of Certainteed Winter Guard along the eaves of the roof,three feet along the sidewalls,three feet around chimneys and pipes,three feet in all valleys and three feet along the rakes. 6. Next, apply a Certainteed Roofers Select felt paper to the remainder of exposed roofing area. 7. All wall flashing will be inspected and replaced as needed. Any and all rotted or damaged trim or siding that needs to be replaced to ensure proper flashing will require a Master Carpenter and will be billed out at an Hourly Rate plus material cost if completed by Superior Industries,Inc. Any and all lead or copper wall flashing which needs to be replaced or installed will be done so at an additional charge. 8. All skylights will have ice&water shield around them. Older skylights may require new flashing kits, which will be purchased and installed by Superior Industries Inc. at an additional cost. 9. Chalk lines every five inches. 10. Install eight-inch aluminum drip edge to all rakes and eaves. (BROWN) 11. Install pipe flanges as needed. 12. All shingles will be fastened using 1 '/4-1 '/2 hand nails. 1-888-618-ROOF (7663) 978-425-0812 Fax 33 Great Road • Shirley, MA 01464 Serving New England • 13. Apply a fifty year Certainteed Landmark 50 shingle. Color: 14. Re-lead chimney?YES(1) 15. Install Shingle Vent II ridge vent on the house to allow for proper ventilation 16. Install 4"x 16"eave vents?NO(circular vents existing) 17. Work site shall be cleaned on a daily basis and all areas will be gone over with a magnet to pick up the nails. 18. Superior Industries will supply the customer with any and all permits pertaining to the job. 19. Superior Industries will furnish a Certainteed warranty that entitles homeowner to 5 full years of non- prorated coverage including labor,materials,workmanship errors and disposal costs. 20. Superior Industries will supply the customer with a liability($2,000,000.00)and workers' compensation ($1,000,000.00)insurance certificate. (All workers are employees,not subcontractors.) Massachusetts License#144428. Better Business Bureau#83356. 21. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. Any and all carpentry not stated in the original contract will not be started until the roofing contract is complete and paid in full. 22. Payment to be made as follows: 1/3 deposit due upon signing, 1/3 due halfway through the job and the balance due upon completion of the job. All Jobs to be started approximately 30 days after contract is signed& deposit is paid (Pending Weather) Total Investment: $ 11,200.00 Complete roofing system $ 350.00 Re-lead chimney $ 11,550.00 SPRING SPECIAL!! S 00!! SIGN UP NOW!! $ 10,850.0 Prior to Superior Industries commencing the Roofeng project, a Supercar Representative must inspect attic for mold. (Si_4Av Rep Signature) (Customer Signature) Comments: To install the Landmark 30 instead the spring special price will be$ 10,150.00. To include the back screen porch the additional cost will be$400.00. See the separate quote for the gutters and trim board replacement. Any questions please call me at 978-580-9571. Thank you, Rick Lundgren. QUOTE GOOD.FOR 60 DAYS NRfQ%AL ROOAPIG CONTRACTORS ASSO17 614k mil Elite MEMBER e r ' ® r SfLfCT SHINGLE ROOFER OCA Certalri�ed� INDUSTRIES, INC. �MS.IXfN6tNGE�1RXLi0hf L60galOX ROOFING CONTRACT Sales Rep: This ROOFING CONTRACT(this"Contract")between contractor(the"Contractor")and owner(the"Owner")named below OWNER CONTRACTOR Name: l Pi 4 j SUPERIOR INDUSTRIES,INC. Address: HMV Mea9'9LA-' e.1' 33 Great Road City: /l). f} 'v?.PC Shirley,MA 01464 State: lg Zip: C�i�5�/5~ 888-618-7663 Ext: /07 Mailing address(if different): �78--S,50 -2<-71 —Cell Number Address: Registration#: 144428 Exp.10-4-06 City: Federal Tax ID#:043518271 State: Zip: Day: 5Q6-5e7'(2 Evening: 1?76 -(089Z'-7�,,(7 Alt: We propose hereby to furnish material and labor-complete in accordance with specifications below: Existing Roof consists of#of Comp layers + #of Wood layers Ridge to install t Roof to Install: Manufacture IJ_T_,'k5i-? Type I-P-e j 1: 7a )( C1 Color jkwla4-TIfI cLIkI 4010 Drip Edge ❑ Vented Drip Edge (Color) �i WQ �t [�Re-lead Chimney E] Soffit Vents (4"X16")Approx.Quantity This contract is dated (Month/Day/Year). The work under the Contract is scheduled to begin on or about Li/3 1 10—, (Month/Day/Year)and is scheduled to be substantially completed on or about ��,3C)�!?\ (Month/Da/Year y );provided,however(i)such scheduled dates of beginning and completion are subject to change due to unforeseen circumstances,and(ii)the Contractor shall have no obligation to begin work until the Owner has paid the Initial Advance(as hereinafter defined). The scheduled dates for beginning and completion are estimates only,and the Contractor shall have no responsibility or liability for reasonable delays in beginning and completing the work hereunder. In addition,the Contractor shall have no responsibility or liability for any delays arising from permitting requirements,the Owner's loan approval and funding,loan disbursement,acts of God, weather,strikes,lockouts,boycotts,or other local labor union activities,job changes requested by the Owner,inability to secure materials,tabor shortages, failure of the Owner to make payments when due,delays caused by inspections,changes caused by inspectors,delays by the Owner in making selections,or any other cause beyond the Contractor's control. The work described below is to be performed at the following property(the"Property"): r� r'Z`�1' w �• N� �V�L. P 9 The following is a detailed description of the work to be performed and the materials to be used in the performance of this Contract:Refer M attached estimate. Such work and materials are hereinafter referred to as the"Work." This Contract shall not be construed as requiring the Contractor to perform any work or to install any items or materials except expressly set forth above. In the event that the Contractor determines that certain materials are not readily available,the Contractor reserves the right to substitute materials of equal or greater value. Prior to the Contractor beginning the Work,the Owner shall pay to the Contractor the sum of$ -7 111 X Q O (the"Initial Payment")in advance,which amount(if this Contract is for Residential Contracting)shall not exceed the greatef of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made nature,which must be ordered in advance of the commencement to the Work. Thereafter,the Owner shall make progress payments to the Contractor as follows: 1/3 Deposit-1/3 Middle Payment-1/3 Final Payment. The owner is signing below to acknowledge that the Owner has been advised of this cancellation right described in detail on the back of this Contract and also on the notice of cancellation form. y �f lI OWNER: Print Name: �2,4 �w VG J Print Name: ALTERNATIVE DISPUTE RESOLUTION (SEE BACK SIDE OF CONTRACT,NUMBER 29,FOR DETAILED DESCRIPTION) THE CONTRACTOR AND THE HOMEOWNER MUTUALLY AGREE THAT IN THE EVENT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT,THE CONTRACTOR MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION THROUGH ANY PRIVATE ARBITRATION SERVICES APPROVED BY THE DIRECTOR OF CONSUMER AFFAIRS AND BUSINESS REGULATION,UNDER PARAGRAPHS(a)TO(e),INCLUSIVE,OF SECTION FOUR OF THE HOME IMPROVEMENT CONTRACTOR LAW. CONTRACTOR:SUPERIOR I DUSTRIES,INC.By: '�:% l'd t �1�//C�/i Date: . I3►f�� OWNER:r� Print me: Date: J OWNER: Print Name: Date: BY SIGNING THIS CONTRACT YOU ARE ACCEPTING ALL TERMS AND CONDITIONS DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. CONTRACTOR:SUP IOR INDU IES,INC.By: ��r.� 'i��y!� Date. - OWNER- r Print N me: Date: OWN 6IR: Print Name: Date: 3� B88 ;"VISA. lo-z-On MEMBER North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM in accordance with the provision of.MGeLbc s0e 54, afrom his workBuilding sha I bePermit Number is that the d 9 disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. 7Thedebris will be disposed of in: (Location of F �ilfty) ; Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for project through the Office of the Building Inspector this 9 P 1 l