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HomeMy WebLinkAboutMiscellaneous - 535 PLEASANT STREET 4/30/2018 535 PLEASANT STREET 210/037.C-0031-0000.0 1� PO Box 55098 - - - - - -- - BosTan,A9A022d5=5038—- ------- - -_- --- ---------- -- ------ - - - 617-9511}600 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: LAWRENCE R MICHAUD and DEBORAH J MICHAUD Property Address: 535 PLEASANT ST,N ANDOVER,MA Policy Number: HMA 0215321 Claim Number: BOS00060680 Date of Loss: 5/2/2015 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. Allan Leavitt Claim Examiner 5/8/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3213 Fax: (617) 531-8891 Email: AllanLeavitt@Safetylnsurance.com Date. t:A d ... . NpRT1q �r O °` TOWN OF NORTH ANDOVER " P • - PERMIT FOR GAS INSTALLATION s , SACHUSEt4 N. cis This certifies that . . . . .'. . . . . . :�. . has permission for gas installation . . . . e,47 . . . . in the buildings of . . tAk.(, �?� :. . . . . . . . . . . . . . . . . . . . . . . at . .6,3 S . . . G'``. .'. . _s.�. . ., North Andover, s. Fee.gO.V Lic. No33.3 A:. . . . . . . . . . . . . . . . . . . . j GAS INSPECTOR Check# ✓ , 81, 68 1� •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK: CITY MA DATE a9% c'b� I PERMIT# JOBSITE ADDRESS NAME 1p Ct1 C:�CNav('--)L' j GOWNER ADDRESST�— -- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL _ I EDUCATIONAL PRINT - I RESIDENTIAL CLEARLY NEW:E3 RENOVATION: REPLACEMENT PLANS SUBMITTED: YES —! NON APPLIANCES Z FLOORS- BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ I �._J COOK STOVE DIRECT VENT HEATER { DRYER FIREPLACE I FRYOLATOR FURNACE — GENERATOR - GRILLE INFRARED HEATER [� LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER f ROOF TOP UNIT TEST I I_ _ I L r J m —J I —AL— UNIT _ UNIT HEATER UNVENTED ROOM HEATER WATER HEATER j — OTHER �T _ l_ I -_ � I ---- - - -- _ 1 [�! Q . z I —J ._ I -J jI INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES .J NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF C VVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYOTHER TYPE INDEMNITY Ej BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT [�I 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 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 complianc ith Pe in t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. e2� PLUMBER-G SFITTER NAME Cvc�z ��3 S� LICENSE#_'135 SI TURE MP ED MGF __I JP D JGF 0 LPGI�( CORPORATIO _ # _aid_. ( PARTNERSHIP ED#�( LLC DI#� � COMPANY �jNAME: �* or a� s eco RADDR'���'��� � ESS \off vS CITY STATE[Q�-NZIP O\ga. TEL eI`�'^llz'&Z (� ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT �;_-7 7/-z ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i ALI'\ The Commonwealth of Massachusetts Department of Industrial Accidents Office ofinvestigations ..600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPlicant Information Please Print Le ibl Name(Business/Organizafion/individual):�� - - Address: City/State/Zip y1�1`�,CS C� ��Q�� Phone ���� re you an employer?Check the appropriate box: TyENew f project(required):' T am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).*, have hired the sub-contractors 6. 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. .0 Demolition working for me in any capacity. workerscomp,insurance. [No workers'comp.insurance 5. El We are a corporation and its 9. Building addition required.] officers have exercised their 10•❑Electrical repairs or additions 3.E1.1 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 noQ Roof repairs insurance required..]t employees. [No workers' COMP.insuranoe required.) 13. Other $ �.t:Y ESI.+Can:that CheC:.s box el must also sill out a coon bA.ov:sho;•rir. - b. :• =.c c� r Lsa ion poficy iazormstioa. 7 Homeowners who submit this affidavit indicating they are doins all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that isproviding workers'compensation insurance for my employees. Below is the policy andjob site information. �Insurance Company Name: Policy#or SBIff ins.Lie.#: �� ��v Expiration Date: Job Site Address. S �`� ' City/State/Zi :� VAC P 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 ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un er the pa nd pe hies ofperiu;Y that the information provided ac b�ov is true and correct: Sisnature: Date: d= Phone#: C�•�y� —`>�� Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): - 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: . M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of-the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employers 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 6r 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 submittedto the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date'the affidavit. The affidavit should be-robarnod tc the mv or to that 0,application-for' "e---L&L pr LicEr.1S being request-.d;L�C1t the r 2T['T!e'lt 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 wouldlike to thank you in advance f6r your cooperation and should you have any questions, please do nbt-hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth ofMassaehusett:s Department of Industarial Accidents Office ofY res.tlbafio.ns 600 Washington Street Boston,MA.02111 Tel. #6.17-727-4940 ext 406 or 1-8.77 ha- SSA.EE Revised 5-26-05 Fax#617-727-7749 s -D � Date`��.��.......�.... NORTH TOWN OF NORTH ANDOVER O A PERMIT FOR WIRING ,SSACMU This certifies that ..... .. ... H. ...... ........... j r has permission to perform ........... wiring in the building of.. .... .......................... at.................1...: ...`....-r��............. ,North Andover,Mass. d _ i Fee: S. p'........ Lic.No ..?4 .. _ ......;...;........ !.... ELECTRICALINSPE r6i Check # A0 'F 79 -;9 ♦J' \\ V G�� �� 'R f Commonwealth of Massachusetts Official Use Only rf Department of Fire Services Permit No. Occupancy and Fee Checked 3S BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) h APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3 - 2-0- 02 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) S3,6— pl easa,ti f yd-- Owner f- Owner or Tenant a r r xt M b G h a u _q Telephone No. `j 7k Gk-? Owner's Address S Is this permit in conjunction with a building permit? Yes [1? No ❑ (Check Appropriate Box) Purpose of Building * t le- -�y yn 1 l .7 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: M �4,e,- 13 u.I k r P yrz cyd e ( � S it S H2,4,f Lv w l h , rl%e W z a x!n rlL e r e te.�?� 4 of I- �►rlJ Q S 1'Y�a�'�2 d,4,yt�k. lowing table may be waived by the Inspector of Wires. Completion of the fol No.of Recessed Luminaires / No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o.o Emergency Lighting ■ rnd. rnd. Battery Units • No.of Receptacle Outlets / No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.o Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers HeatTotals:PumP Number Tons KW No.of Self-Contained I. _ t Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KNo.of No.of Data Wiring: W Heaters Si ns Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 14 a ci 0 (When required by municipal policy.) Work to Start: 3 • 20—c- 7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless ' the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE []BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and comP lete. FIRM NAME: 7 G Leye -5 C—u T "C- LIC. NO.: j�- 5117 Licensee: JOS Pd G /� t Signature LIC. NO.: (If applicable, enter "exempt"in the license nun ber line.) Bus.TelNo.:9 71y'&Cr7 2 783 Address: l (0 CJ ��@&$d hPiv_p .Alt.Tel. No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety "S" License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ / Signature Telephone No. / J""LTV Date. . °' "�o':'� TOWN OF ORTH ANDOVER t . o PERMIT FOR PLUMBING at a SSAC04USE� s This certifies that J.�.e. . . . P'7. £. . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . plumbing in the buildings of .// !.�. .c. . s� . . . . . . . . . . . . . . . ". �r`4 t fi s. Y' at. . .�.�.�. . . . :�. . . . . . . . . . . . . . . . . . . . . . .�., North Andover, Mass. Fee. Lic. No.. / . . . . . . . . '1 . . . . -: . . . . . G PLUMBING INSPECTOR Check # { !� 7322 I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS �/L /0 7 Date / Building Location ��� - ers Name i Permit# 7,74 L Amount —k - Type Type of Occupancy ,/ New Renovation Replacement Q,-- Plans Submitted Yes E] No El FIXTURES w a >4 En 9 W H W Z F a a F w � W a ;" H AEA ' H A x w w t SLRE&a .I RSIIM a 1A ROQR ZU FLOCR 4IH HIM 5M KfM M KaR / 7M ROQ2 9MRIM -47 (Print or type) Check one: Certificate Installing Company Name J IeScLy 1 � Corp. Address 0 Partner. Business Telephone 3,Fir /Co. Name of Licensed Plumber. D Insurance Coverage: Indicate the type of insurance coverage by checking 4Ke appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner Agent I hereby certify that all of the details and information I have submitted r ntered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations p ed under Permit Issued for this application will be in compliance with all pertinent provisions of the sach efts State to ing Code and Chapter f the General Laws. By: ature ofbicensea FIUMDer Type of Plumbing License Title 6F / 2 's —o City/Town License Numoer Master Journeyman APPROVED(OFFICE USE ONLY rp � () Date. . . b'6 o� Na oT"9ti TOWN OF NORTH ANDOVER 3 C.r�4T� RGiJ4 INSTALLATION oAllidaw p QO4�re o^w°�4h �9SSACNUSEt V p 4 # �^L {^13Si�.�4ifFo.Vtt•�Ss4. This certifies that . JJ f. . . . . . . . . has permission for gas installationf .. . . . . r in the buildings of . . . . fifC . . . . . . . . . at . . . .(.J {. . : �3�. ,, North Andover; Mass. r(( GAS INSPECTOR WHITE:Applicant ANAR . Building Dept. PINK:Treasurer GOLD: File . .. ••••�• ...�tir�� '+�-r�r�.F►Itury FVH PEHMIr TO DO GASIFIT�"ING : (Print or Type) 6 NORTH ANDOVER , Mass. Date T 19Building � LLocatl n Permit # Owne Name me New ❑ Renovation p Replacement p plans Submitted: Yes p No [p n a >< s c ri u h at h M 11- OC w o �! J_ pp W h O d y x M X O aG< 0, a O h H O 7C M N d MM < O X, 1<y F9 . lert Mtl0 IL MW 00 ' t `x 0 a 31o, lei . Surr-139MT. •A'IMINT ! 10T FLOOR IND,FLOOR ,Rb FLOOR ' 4TH FLOOR i dTH FLOOR ! STH FLOOR 7tH FLOOR 0TH FLOOR Qp Check one: Certificate Installing Company Name /L z1f6 7 Corp. Address 6 e Q [i partnership 6 _ 11Firm/Co. Business Telephone 7SS Name of Ucensed plumber or Gas Fitter INSURANCE COVERAGE: Check or}� I have a current liability Insurance policy or its substantial equivalent. Yes L`T No p If you have checked•yea, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of indemnity ❑ Bend O 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 Vgent Owner ❑ Agent❑ I hereby certify that all of the details and Information 1 have Submitted lot entered)M above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for Ihla appllcallo 11 be n compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Omer T of lkense: Title Plumber na urs o nae um er or as er aster License Number �'/T� Joumeyman APPROVED(OFFICE USE ONLY) Location 3 b-- s No. oZ Date `� / 4 �oRTM TOWN OF NORTH ANDOVE ,•,hoR n Certificate of Occupancy $ Building/Frame Permit Fee $ �ssw�HusE< Foundation Permit Fee $ Other Permit Fee $ M Sewer Connection Fee $ Water Connection Fee $ TOTAL $ JAPAr6L -- Building Inspector 3 u 6 5 Div. Public Works VERMIT NO. / p APPLICATION FOR RMIT TO BUILD********NORTH ANDOVER, MA MAP NO. LOT.NO. 2. RECORD OF OWNERSHIP DATE BOOL{ PAGE ZONE SUB DIV. IAT NO. 7 LOCATION �J ��S A te' S� PURPOSE OF BUILDING r�S /� /� ?� 2 f� � oo F OWNER'S NAME Z 6 i I NO.OF STORIES ! SIZE OWNER'S ADDRESS - /�� f _ �_ 7 - BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1 T 2ND 3RD BUILDER'SNAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER $OARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTUCTIONS 3. PROPERTY INFORMATION eC )o LAND COST /C / EST.BLDG.COST p PAGE I FILL OUT SECTIONS 1-3 [/ EST.BLDG.COST PER SQ. FT. EST.BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED / /OWNERS TEL## i -- ��.j _ CONTR.TEL## 9Z-If/ /������y 6 SIGNATURE OF OWNER OR AUTHORIZED AGENT CONTR.LIC## L/J� H.I.C.## FEE $ PERMIT GRANTED 19 Revised 11/97 JM TravelersPropertyCasualtyJ WORKERS COMPENSATION e ss�n�:a AavelersGroup AND EMPLOYER&LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6NUB-449X779-3-98) NEW-98 INSURER: THE PHOENIX INSURANCE COMPANY NCCI CO CODE: 12610 1. INSURED: PRODUCER: RAYMOND DAMPHOUSE & SONS INTERNET INSURANCE AGCY ROOFING CO INC 525 CHICKERING RD P 0 BOX 431 NORTH ANDOVER MA 01845 LAWRENCE MA 01842 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 08-22-98 to 08-22-99 12:01 A.M. at the insured's mailing address, 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compen- sation Law of the state(s) listed here: MA Im B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit 0 Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: <� SEE ENDORSEMENT WC 20 03 06 D. This policy includes these endorsements and schedules: o SEE LISTING OF ENDORSEMENTS,- EXTENSION OF INFO PAGE 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating `= Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 09-25-98 GL ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: INTERNET INSURANCE AGCY 753XF 001681 92. asaclwjeez t DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE t ,4 Number.,:,K. Expires: Birth da te: I 1 .. CS 046636 0610211999 06102/1948 l t- Restricted To: 1G RAYMOND E OAMPHOUSSE JR �' ►+••x Orvw T5 BUTTERNUT LANE METHUEN, MA 01844 HOME IMPROVEMENT CONTRACTOR I, Registration 101862 Type - PRIVATE CORPORATION 1 Expiration 06/29/00 i RAYMOND E. DAMPHOUSSE, JR,. & Raymond E. Damphousse, Jr. 75 utterRut Lane Methuen MA 01844 TOR ADMINISTRA J J, T Town of North Andover oT" 4, f 1 OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° : to i r< 27 Charles Street `" North Andover, Massachusetts 01845ySSACHuSE��y WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 a I In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number o is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) ignature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 • f RAYMOND E. DAMP80USSE, JR. AND SONS ROOFING CO., INC. BOX 431 LAWRENCE P.O. MA. CONSTRUCTION LAWRENCE, MA 01842 SUPERVISOR LIC. #046636, TEL: 683-4588 HOME IMPROVEMENT REG. #101862 ROOFING — SIDING — INSULATION Date From: .d...,,: .:i!. ! ? (Name) (Address) To: RAYMOND E. DAMPBOQSSE, d9. AND SONS ROOFING CO., INC., BOX 431 LAWRENCE P.O., LAWRENCE, MASSACHUSETTS 01842 1 (we) hereby authorize the Contractor to furnish all materials and labor necessary to install, construct and place the Improvements described below in-on building located at No. Street, City State %. in accordance with the following Specifications: All y All of the above work to be done in a good and workmanlike manner. All men and equipment insured. Premises to be left clean upon completion of work. For the total sum of dollars. Entire Sum to be paid immediately upon completion in accordance with plan as shown below. ITOTAL CASH SELLING PRICE . . .. . . . . .. $ y� , ' DOWN PAYMENT IN CASH . . . . . . . . . . . . . DEFERRED BALANCE UPON COMPLETION . . . . . . . . . . . . . . . . . . The undersigned agrees to keep property mentioned in this agreement properly insured against loss by fire including the Contractor's interest therein. This agreement shall become binding only upon the written acceptance hereof by said Contractor, and upon such acceptance this shall constitute the entire contract and be binding upon the parties hereto, there being no covenants, promises or agreements, written or oral except as herein set forth. It is the intention of the parties hereto that this contract shall be binding upon their respective heirs, executors, administrators, successors and assigns. Customer agrees to pay a reasonable sum as attorney's fees and Court Costs if placed in hands of attorney for collection. The owner further agrees that in event of cancellation of this contract after acceptance by the contractor and before the work is commenced the OWNER agrees to pay 20% of the total consideration herein named as liquidated damages for breach of contract. Said contractor shall not be responsible for damage or delay due to strikes, fires, accidents, or other causes beyond his reasonable control. We, the undersigned, certify that we are the sole owners of the property herein described on which said work or repairs are to be performed. IN WITNESS WHEREOF, the undersigned has (have) hereunto set his (their) hand(s) and seal(s) the day and year written above. Accepted By Ausband r' RAYMOND E. DAMPHOUSSE, JR. AND SONS Wife ROOFING CO., INC. ter'' Mail Address ,l pf different from above) f (Signature and fiitle of Ofliciaq r'! 140, TFC 0" of C ....•.::'..: ''.` 0� ®ver 0 o� CoCHICTIE � dover, Mass., ay A�"?ATE D 7.. - BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT.......... r V BUILDING INSPECTOR AA 0 S .. .................... ...... Foundation has permission to ewct.......��.;:.. ............ buildings on ...................................�` .4.................... ...... Rough r•a • Q to be occupied as................ t� �'! �"` d Root �� himney .................................... .... ................................................... . ................................................. 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. PLUMBING INSPECTOR VIGLATION of the Zoning or Building Regulations Voids this Permit. Rough C PERMIT l� EXPIRES1N6 1V ONTT-IS Final UNLESSCONST ' - ELECTRICAL INSPECTOR C ....................................... Rough Service BUILDING INSPEC OR Lzol' Final Occupancy Permit Required to Occupy Bui1ding GAS INSPECTOR s Display in a Conspicuous Place on the Premises — Do Not Remove Rough • 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.