Loading...
HomeMy WebLinkAboutMiscellaneous - 573 MASSACHUSETTS AVENUE 4/30/2018 �-� 573 MASSACHUSETTS AVENUE 210/045.0-0001-0000.0 Location S7 - rn rl 5 5 r No. 01-7 Date L • TOWN OF NORTH ANDOVER ����sem;;t °�'�� �, • Certificate of Occupancy $ i Building/Frame Permit Fee $1y�i''"� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Ll7 E� J U 9 L) `Building Inspecto f VOR q A44 -6 urz, BUILDING PERMIT ?o`t(,�o...`�, TOWN OF NORTH ANDOVER ° � APPLICATION FOR PLAN EXAMINATION a - Permit NO: ��/ ��� Date Received LL �•9 ^reo'PEgS Date Issued: ® I1! s 3ACHUS IMPORTANT: Applicant must complete all items on this page LOCATION S 7 3 M c-5 S c,,_Gi<yi c .{ /qy-'n Lk Plv/ PROPERTY OWNER �.c rt0. I rV tt fid- - cr f/�r�o ;✓n u; 2 Print MAP NO: 6y PARCEL 000 ZONINGDISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building of One family ❑ Addition ❑ Two or more family ❑ Industrial ®Alteration No. of units: ❑ Commercial KRepair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other " ❑ Septic 0 Well ❑ Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer Identification Please Type or Print Clearly) s-' OWNER: Name: ��, rti %c� ;; - - Phone ' Address: CONTRACTOR Name: �� �z y Phone: < 7 S`7 4/ —0"4 f Address: ' Su ervisors Construction License: P d j -1"`? Exp. Date: Horne Improvement License Exp. Date I t� l {�� C) C/ P ARCHITECT/ENGINEER Phone: r Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ . , FEE: $ Q Check No.: 3 V 7 (o Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner ._ ., -1y4— I Signature of contractor Plans Submitted [I Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans F] , TYPE OF SEWERAGE DISPOSAL . Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATEAPPROVED OVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes - no Located at 124 Main Street Fire Department signatureldate COMMENTS NORTH q Town of s ndover 0 Ah ver, Mass, q • ' d/ S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ...........C.......:1.. ... .. ..S.................�... ...ft.. .................................... BUILDING INSPECTOR has permission to erect buildings on .......r 44. *. .AVC0 Foundation Rough to be occupied as ................. ..... ....................................... .................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCIM START Rough CService ........ ..... ......... .. ... .. ...................... 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. 30 t g� �=�+ A & A SERVICES, INC. YICW 115 NORTH STREET, SALEM, MA 01970 IMUTRORMISMOMMUM 'Telephone:(978) 741-0424 Fax: (978) 741-2012 Contractor Registration No. 101609 Construction Supervisor No.CS057733 Federal EIN:04-3090162 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Bu er(s) Name Date of Contract — Buyer(s) Street Address,City,State and Zip Code Da Ime Telephone Number Evening Tele one Number Mobile Telephone Number E-Mail Address r ?-3G.5 q? 162-&Y7.-Z Et,7 lb-,Ylvt S i if The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement"),and Buyer(s)have requested that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.("Contractor"),hereby agrees to install or cause to be installed the products or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a cash sale of goods and services.The Buyer(s) agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. Purchase Price: ( � Est.Starting Date: Down-Payment: lS Est.Completion Date: 13,Cash Amount Due on Start of Job: Check 1 Credit Card Amount Due on of Completion: No. Amount Due on of Completion: Expiration Date: 4' Balance Due on Upon Completion,", CVC Code: It is agreed and understood by and between the parties that this Agreement,front and back and any addendum, constitute the entire understanding between the parties,and there are no verbal understandings.chahging or modifying any of the terms of this Agreement.Buyer(s) hereby acknowledge that Buyer(s)has read the front and the reverse of this agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notice of Cancellation forms,,on the date first written above.Buyer(s)also(i)acknowledge that they were orally informed of their right to cancel this transaction;and(ii)request that they be contacted via their telephone numbers or email,as listed above,in the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Contractoc'DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A S!ep3*pes�Inc. Buyer(s) By: Signature Signature r � / L Print Name PrintName Signature Print Name You,the Buyer(s), may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. ARBITRATION:The contractor and the homeowner hereby mutually agree in advance that in the event either party has a dispute concerning this contract,either party may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive office of Consumer Affairs and Business Regulations and the other party shall be required to submit to such arbitration as proved in M.G.L c.142A. Cemractor initials:I V�5 Buyers lnit'ulc.� Datc: ey—7 Dote: Q I 1 1 W NOTICE OF CANCELLATION NOTICE OF CANCELLATION Dateof Transaction —7-�4�..You may cancel this transaction,without any penalty or Date of Transaction (`-7-IJO.You may cancel this transaction,without any penalty or III obligation,within three business days from the above date.If you cancel,any property traded in, 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 instrument executed any payments made by you under the Contract or Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller of your cancellation notice, by you will be returned within 10 days following receipt by the Seller of your wncellatlon notice, and any security interest arising outof the transaction will be cancelled.If you cancel,you must 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,and substantially in as good condition as when make available to the Seller at your residence,and substantially in as good condition as when received,any goods delivered to you under this Contractor Sale:or you may,if you wish,comply received,any goods delivered to you under this Contract w 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 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 expense and risk.If you do make the goods available to the Seller and the Seller does not pick Nem up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of goods without any further obligation.If you fail to make the goods available to the Seller,or if you the goods without any further obligation.If you fail to make the goods available to the Seller,or it agree to return the goods to the Seller and fail to do so,then you remain liable for performance of you agree to return the goods to the Seller and fail to do so,then you remain liable for performance all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated of all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated copy of the cancellation notice or any other written notice,or send a telegtsam,,tq A&A Services, copy of the wncellatlon notice or any other written notice,or send a telegram,to A&A Services, 115 North Street,Salem MA 01970.NOT LATER THAN MIDNIGHT OF[[7- ) 115 North Street,Salem MA 01970,NOT LATER THAN MIDNIGHT OF G �I LMy rneral morel I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION Consumer's Signature Date: Consumers Signature Date: `h+ Abrade Phone: 978-741-0424 Above Fax: 978-741-2012 p� ,�i�='<l MMS e1982 www.a-aservices.com ACL �ER 1yJ MMS 115 North Street o : • o Salem, MA 01970 Date: 1--7 —`i7 Work Specifications for Roofing Project Name: SOV `7- 40-1WA-YAJ Address: 5_73 //,io-5S A/ me o/6?Vf City: State: Zip Code: Areas to Be Re-Roofed: Roof Areas Excluded from Re-Roofing: S� L Pull Permit with Community as Required. ( Waste disposal is included using either dump truck or dum ster. If dum ster is utilized i p p (site location: l" as agreed to by the home owner), it will have plank stock put under dumpster as property protection. Tarp house from fascia board to ground and beyond to protect house from falling roof shingles. A&A Services makes every attempt to protect home, decks, driveways, landscaping, and shrubs. Due to the heavy weight of roofing shingles coming off the home we cannot be responsible for damage to landscaping and shrubs. E51 Strip roof of fi' L� layers of roofing shingles. Inspect roof deck after removal of shingles for any rotted wood. If any replacement is needed, the first 32 sq.ft. is included. For any other repairs: 48 sheets of plywood removal and replacement will be billed at $1ST per sheet. TheS�ixcharge for resheathing deck with 1/2" of plywood (go over existing roof deck), if needed will be $ 7'5 d per sheet. Planking replacement is billed at$ per linear ft., and carpentry repairs at $ `� P r "'per hour. Install GAF storm guard leak barrier 6' u roof from edge of fascia board c ' P g ( ode calls for 3). A&A Services is dedicated to using extra ice dam protection in our unpredictable New England weather. GAF storm guard leak barrier/ice dam protection material is a flexible membrane that sticks to the roof deck to prevent it from moving when shingles are installed over it. This membrane self-seals when nails are driven through 021 so water cannot leak through it. Install GAF storm guard leakbarrier 18" in from edge of rake leave areas of the home). This prevents wind-driven rain from penetrating the edge of your roof and causing leaks. Buyer Initialsk Date:ALI ZAA&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan.2015(2).docx + Phone: 978-741-0424 Abrade Above Fax: 978-741-2012 n, Since 1982 www.a-aservices.com A&AE1 51�_ES 115 North Street /o • • ® Salem, MA 01970 P/ Install GAF storm guard leak barrier 36" in valleys of home and at any roof penetration such as chimneys, exhaust vents, vent pipes and skylights for added protection against leaks. Install F-8" drip edge to perimeter of the roof deck. Drip edge helps support the roofing es shingle at all edges 9 of the roof, manages water flow off roof and into gutters, and also protects against wind-driven rain —/ penetrating the edge of the roof. Available in 3 colors: Mill (Aluminum), Brown, and White. C Install GAF deckr a mor to remaining area of the roof that Is not covered with GAF storm guard. GAF deck armor adds another layer of protection against leaks from wind-driven rain. It being extremely breathable, lets moisture escape from attic space and helps preserve your roof deck. Install GAF ProStart starter shingles at perimeter g p Imeter of roof. This Is Important because the starter shingle has additional adhesive which prevents the first row of shingles from blowing upward in heavy winds. Lyf Re-flash chimney: remove and dispose of old flashing, cut into mortar with grinder approximately 8" Pp Y up chimney, feed new lead into newly cut mortar joints, install lead in a step-flashing manner, and run approximately 4" onto roof deck. Seal all edges with Geocell sealant. Lead is used as a flashing material on chimneys because it is very pliable. Lead flashing molds to uneven surfaces and stays in place for years. L]/ Install aluminum vent pipe boot with rubber gasket around all vent pipes and then seal with Geocell C3/ sealant. This application prevents leaking around vent pipes. Replace or ❑ Cut in For& Install Broan roof bathroom exhaust vent(s)with adapter and seal with GeoCell. Ventilation is a requirement for long-term roof performance and warrantee validation. It will reduce energy consumption and create a healthier and more comfortable home environment for you. A&A Services will utilize the following type of ventilation system for your home: Gable Vents: Add: Utilize Existing: • Expand Existing: Soffit to Ridge: (Soffit Vent as Intake)Add: Type: • (Ridge Vent as Exhaust) Cut in as required and add GAF Snow Country Baffled Ridgevent to ridge(s). Location: Aluminum Slant Static Roof Vents: # Location: Mechanical Ventilation (Electrician Not Included): # • Type: Location: Buyer Initials U946 Dat u ZAA&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan. 2015(2).docx 021% Phone: 978-741-0424 A Grade Fax: 978-741-2012 Above Since 1982 www.a-aservices.com A&A SVKC�`E.S 115 North Street © • • o tae cWv t Salem, MA 01970 Install GAF Roof Shingles Style'Arr 1�1? t WWF- Color: 1VA?V` tAC-J< C7— rn2N/n! /Nail locations vary by shingle and roof slope. It is critical to fasten the shingle in the proper locations in order to achieve desired performance and meet warranty requirements. • All nails that will be used on your roof will be barbed or rough-shanked nails and will be resistant to corrosion. • In most applications, shingles will receive 6 nails and all nails will be long enough to penetrate min. 3/4" into the roofing deck. (Using 6 nails per shingle and utilizing ProStarter shingles at rakes and soffits upgrades the wind rating of your roof to 130 mph. Install GAF Timbertex premium ridge cap shingles with approximately 8" exposure. These shingles add the finishing touch to the peak and/or ridges of your home. They are also designed to handle some of the toughest areas of roof protection. TimberTex ridge cap shingles are much thicker and have self-sealing / adhesive that seals each shingle tightly and helps reduce the risk of blow-off. CV' Install GAF Seal-a-Rid a Cap Shingles with approximately 5" exposure to ridges. [ Clean off roof with blower to remove any debris. Clean out gutters of any roofing debris. Rake clean all work areas. Leaf-Blow the perimeter of work areas. Go over grounds with magnetic rake to pick up any loose nails. Please note: you may want to cover your attic belongings due to roofing debris sometimes / falling through the gaps in the roof deck. That cleanup is not included. D This is a safety equipment project. We value our help and are concerned for your liability. I/ Supply owner with partial leftover bundle of shingles to have in the future if needed. A&A Services is a certified GAF installer. We follow all Massachusetts building codes and GAF manufacturer's installation requirements. By doing so, your roof qualifies for a 50 year non-prorated warranty from GAF. See warranty for more details. a/ Massachusetts Law requires contractors to warranty their work for 1 year against installation defects. A&A Services offers warranties for their roofing work for 10 years against installation defects. If any problems occur at any time, A&A Services will come out free of charge to evaluate and help our customer through any manufacturer's warranty claim. Miscellaneous: -t- �'^—tAsS 7)9-vV �>15 7 tL, �ayQ- ' 7'L�-17o-.^1 xqj�7A 9'sA A- Buyer l�Sig ture Salesman Signature Date: ll `3 4/ L� Date:�� Buyer Pri t Salesman Print ZAA&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan. 2015(2).docx The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): � i U C Ih Address:_ (5�Mo City/State/Zip: MA-00 G phone#:_ Are you an employer?Check the appropriate box: 1.©7 Type of project(required): I am a employer with 4. Q I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.Q I am a sole proprietor or partner- listed on the attached sheet.t 7. Q�Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. workers'comp.insurance. o workers'comp,insurance 5. g• Building addition � p. ❑ We area corporation and its required.] officers have exercised their 10.Q Electrical repairs or additions 3.[:] .Q I am a homeowner doing all work right of exem tion per MGL 11. Plumbing lumbin r P ❑ repairs or additions g P myself.[No workers'comp. c.152,§1(4),andwe have no 12.❑ Roof repairsinsurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other Any applicant that checks box#I 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 cheek 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. Belo information. w is the policy and job site Insurance Company Name: It' Policy#or Self-ins.Lie.#: 0Expiration Date: -( Job Site Address:. /xC a City/State/Zip: , 4 1 La �f A O'�11 lLS_ 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 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. :do hereby certify n er apains and penalties ofperjury that the information provided above is true and correctature: Date: Phone#: Official use only. Do not write hi`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#: ACOO CERTIFICATE OF LIABILITY INSURANCE 7DATE(MMIDDIYYYY) �� C19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED r=PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. PORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME, David Barrese EA Stevens Company, Inc. PHONE (781)322-2324 FAX AIC Nol:(781)397-7672 389 Main St. E-MAIL ADDRESS:davidb@eastevensins.com P. 0. BOX 188 INSURERS AFFORDING COVERAGE NAIC q Malden MA 02148 INSURER A:Liberty Mutual Insurance Co INSURED INSURERB:Safety Indemnity Company 33618 A & A Services Inc. INSURER C: 115 North Street INSURER D: INSURER E: Salem MA 01970 1 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ CBP8799047 8/14/2016 6/14/2017 MED EXP(Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JPRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ j 4UTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1\ Ea accident $ 1,000,000' B- ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS 6209032 2/9/2016 2/9/2017 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB I I CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE H OFFICER/MEMBER EXCLUDED? N I A E.L.EACACCIDENT $ (Mandatory in NH) ifE.L.DISEASE-EA EMPLOYE $ yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ .JL DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached ff more space is required) CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. Building 20, Suite 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Thomas Cares, Jr/VH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 tgnwin 30 Phone: 978-741-0424 18' 0= Fax: 978-741-2012 wv/w.a-aserd ces.ccm M&A 19 C 0 115 North Street s Salem, PAA 01970 DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M.G.L.c.40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a property licensed facility as defined by M.G.L.c. 111, Sec. 150a. The debris will be disposed at: Waste Management 877-515-2845 c/o Melrose Transfer Station 740 Broadway Melrose, MA 02176 or Waste Management, Dumpster Service at 115 North Street Salem, MA 01970 1 I Signature of �rmit Applicant Christopher Zorzy, President Name of Permit Applicant Date Massachusetts -Department of Public Safety A&A SERVICES, INC Board of Building Regulations and Standards Christopher Zorzy '"'"' 115 North Street License: CS-057733 97-4 Salem, MA 01970 11,11 a CHRISTOPHER 7t0 ; 115 NORTH ST '$ Salem MA 01970% SCA 1_{;, 20M-05111 r ` Expiration Ofrice of Coiisumer Affairs&Business Regulation Commissioner 05/26/2017 RE "HOME IMPROVEMENT CONTRACTOR Registration 10.1609 Type: E /.� Jv Expirat.on:.,.._6126/201,8 Private Corporation 1 A&A SERVICES,INCI Christopher Zorzy 115 North Street Salem,MA 01970 Undersecretary • AMERICAN CLAIMS SERVICE MULTI-LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street Building 20 Suite 2035 North Andover, MA 01845 Insured: Falkner & Hayne Barnwell Address: 573 Massachusetts Avenue North Andover Policy: PHO 0100 84 76 36 Loss Date: October 6, 2015 Loss Type: Sewer overflow ACS File: 32235 Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General 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 file number. Craig Gillespie Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to a an Y Y � 9 pay Y portion of this claim to you. Date 10/7/15 i 7 KIMBALL LANE,BUILDING C,LYNNFIELD,MASSACHUSETTS 01940 TELEPHONE (781)245-9516/FAX(781)245-1077 E-MAIL—claims.acs@verizon.net Date HORTM TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION CHO This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . 7. . . . . . . . . . . . . in the buildings of . . .13?. t . . . . . . . . . . . . . . . . . . . . . . . . . at 5. 2 . . . . . . . . . North Andover, Mass. Fee. .6.4?. . . . Lic. NoP Y). . . . . . . . . . . . . . . . AS INSPECTOR Check# r. 5698 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING Go (Print or Type) p c� -Njo 12TH A w DOVE, .. , Mass. Date 0 6 Permit # --!DG / ' Building Location X572 Owner's Name DbuGt_A,S UA-1-DWiO UV. Type of occupancy P-E-si0yJTi A Z✓ New ❑ Renovation ❑ Replacement P Plans Submitted: Yes❑ No ❑ h N J y cc W N v x CC N W Ucc f!7 cc N cc O N F- x W cc O Um t z z O W F a ¢ _ O Cr a m N 1- ¢ o ° a x r x W d W �. N a C Q N cc W z W x N W a oc o c ' W cr I- r x tl H z J H 2' N W W tl O ? LL H V J H W Y Q W Q C N y. N cp Z O z W O a > W O 2. a a n fA z W ¢ .x O tl x u 3 G tl J V Y p a SUB—BSMT. BASEMENT - - - - 1ST FLOOR 2ND FLOOR At 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOORR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X7 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone 9 7 b-6 8,7-' l 10 5 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability ins ra❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy D( Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b 9 q Y Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in abo pplication are true and accu�te to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application willU n Compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. BY T e of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 74'� City/Town Journeyman _ APPROVEut O HUL USt ONLY F BELOW FOR OFFICE USE ONLY r FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE , N0. ' APPLICATION FOR PERMIT TO DO GASFITTING NAME do TYPE OF 13UILDING a' LOCATION OF 13UILDING PLUMBER OR GASFITTER LIC. NO. I I l PERMIT GRANTED DATE ��9 I GASINSPECTOR r Date. '�.�.G�. NORT/y t �'<. •� .�� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� This certifies that . . . .�s.f'h has permission to perform . . . . LA- plumbing in the buildings of . L r � l ti... . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . d'y�H f /. "` . . . . . . . . . . . .. North Andover, Mass. I' Fee. .. Lic. No.. -6F:�. .7. . . . . . . . . . . . . .� ` . . . . . . . P OWING INSPECTOR Check .H 3 6 d G 7071 :. y 4,s• ..e.,� ""''�. 5" w• a^^-�^•'+[�F'�i�4� v+.✓v n+ . a..�,.+y.i,�, e.y�s t ray a'�-sk s,-�.,d. .w.:r% aN, ��r .wM•r - �..-..A �f -•t?'wwfi�+.1 i LK ..K � ,..� .. . y, .•_,f __ ;��� F Z ^Y A �^� �� t ,w r ` 4 .R�i i ..-k �� Y,; t a wi. 4 S - k. Y • \ Y � 1'�h3• .w i.y,• P eY .. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) r 1 02Uo Tid AgDOVEL , Mass. Date fo Permit# Building Location S 73 HMS AVE Owner's Name ra /r)l 0 . v� is bORRI AiJ.D 9 Type of Occupancy. ELI CCIOTM L, New p Renovation ❑ Replacement ❑ Pians Submitted: Yes ❑ No ❑ B.P.# SEWER# FIXTURES . SEPTIC# •- Z N 4 � Z X rN. of N N O Z > $4 -r a cv Q x W O Z W t- W y f, U Z J N N Of 2 W N Y O. 3 . •ri a Z C a p a C V Z 0 7 ti W Q W Q O Q M ,Z 0: a O ria us x d N a H F' W' W O . J0 W C H Q X O O G t' V } 1-• O T !3. .O :N r.. 2 C 00 N Z X W H o v 0 N CC. a O Q C m A .0 SUB—B S MT. BASEMENT 1ST-FLOOR 2NOFLOOR j 3RO;FLOORAI ; , TI H FLOOR STH IpLOOR r t a} { 6TH FLOOR M 0 ,} Q FL .OR , iv• 8TH FLOOR installing Company Name SAV STATE CtL5 .n Check one: Certificate # :µ Address b5 N A P-ST o ki ST O Cor poration LA W R I JrF h14 A .p Partnership } Business Telephorief9 7 8) :G97- 1105p tR„jeo Name of Licensed Plumber GIS. RZER INSURANCE.COVERAGE: 1 have'a current liability insurance policy or its substantial.equivalent which meets the'requirements of,'MGL Ch. 142. Yes' O ,` No O If you have checked Les, please indicate the type coverage by,checking the appropriate box. A liability insurance;policy ❑ Other type of Indemnity D Bond ❑,, OWNER'S INSURANCE WAIVER:I am:aware that the:licensee does not have the insurance coverage"required-by Chapter.142 of theMass- General taws; and that Amy signature;on this permit;;applicatton waives this requirement. � Checlf one:. gnature of;Owner or t?wner's; ant OWner T:3 " , Agent❑: • a I hereby certify that alt of the`details and Information-1 have`submitted:tor entare above applicatio are e d accurate to'the best of my ktrowledgedand thatali umbing Work and int;taliagons perfoFriied un e. issued foutiiia pf apA be in compliance withWI pertinent pr<msions of.#he Massachusetts State Plambir�g kCode and giapter en ,. JT tle` - �~ 9nature o um r . , } m Type of tic ansa Master.' :Joumeyfnan -- Ucenwe Number, f2� r:, y» a Y4f ,�,.e t f r a ,•t`rr �r yt#*� �t_ r " ,-��.e�i�3S rjc�}�fC.'.i�+�'� .'F�'J A4a 5 f ,r/.r ,��P' ,h�, }'.�•�',� y$ .. y.,, ritT,.; n ; N 7C A x 'O > In ni 19 CA m • � .� a sa. � Z p � • ^IV 10 a � i (a t i t nfw✓f.tory! ( i }.y(,;. `..tx i•r.�I? �-y -(z' rt:P' <.. y a7 z 1( rC �+.« j..� SxT i r �`3 -.I 4 v ati,Y.,-r k� �^3.ti` �.' 7�<..��. +sic t S .Xa �, 5+�t'' SY rt i.•'a t 7,.•a f; z � �' � , �4 �rz •1!i'38�"'f'.si: r �'}y1�fp?�A 'rt �y v��te,' j�y!}'t•. a .. ,r- 'r.�!- � � .. ''.'Ff .•��e+ - �w.7",st^*'d,�' dti,,,�7 t» ti s j*iy "' .J' +� t,�. ;�"�.' i Location �i/ ✓ WS. A U No. / Date { �ORTM TOWN OF NORTH ANDOVER O�t�rao :�'�'y i 3? ' °c �0. � y i i Certificate of Occupancy $ ACMU'S Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ a� Check # -5 14 143 2 , Building Inspector TOWN OF NORTH ANDOVER r BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIE,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ftg _ BUILDING PERMITNUMBER: —8 /`7 DATE ISSUED: ,a12 —z9 SIGNATURE: AfA C6���- Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 573 t1d SsA c,[��s�_ Le- S & C l Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reipired Provided Required Provided 1.7 Water Supply M.G.L.C.Q.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Neq RL<� Name(Print) Address for Service F7 j : n 025 7 Signature Telephone g P 2.2 Owner of Record: Name Print Address for Service: O zp�q M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ iso W_ azz ,) -,J-P, Licensed Construction Supervisor:Pe � O ��7 O License Number �}n �o Vel S s /I✓O�'����/7/`�vCR/tr Address 5 r Expiration Date � Signature Telephone 3.2 Registered Home Improvement Contractor �t Not Applicable ❑ v Company Name -/ /� /` y�2 Registration Num r Addres (P [J Expiration Date /� Signature Tele hone ` ) 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. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 30 PL2 46- m)F'*7L' SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ©I?FICI USE 011L s q Completed by permit applicant 1. Building T �5 0e::) (a) Building Permit Fee 7 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (t,) 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, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, /� e bl VV - +I Ze , 'K as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief �' Print Name Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST2ND 3RD 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 r 91te -- foaar"" mRegu� ns an tan ar�g g One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 109740 Type: DBA Expiration: 09/24/2002 ALLEN CONSTRUCTION CO ROBERT ALLEN 86 ANDOVER ST N ANDOVER, MA 01845 Update Address and return card. Mark reason for change Address J Renewal n Employment Lost Card .,�.e �a-»z•r�za-acurra�l�, a�_,��sur�u�nlla Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Registration: 109740 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 09/24/2002 Boston,Ma.02108 Type: DBA ALLEN CONSTRUCTION CO ROBERT ALLEN 86 ANDOVER ST � w 1 i N ANDOVER,MA 01845 Administrator Not valid without signature r .J1Z6 j149nlsta9tt!!P(tC II a ✓f-f�ri7i�QQ`C/IUi' 4Ll3 ; BOARD OF BUILDING REGULATIONS s f License: CONSTRUCTION SUPERVISOR Number: CS 040927 #, Birthdate: 05/04/1957 Expires: 05/04/2001 Tr.no: 8479 Restricted To: 00 ROBERT W ALLEN 86 ANDOVER STS�i l N ANDOVER, MA 01845 Administrator IIIC l.iVl!!///V//WCdll/l UI /VIdJJdG/IUJV((J Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: t'i a e,-74— w, Ft7ZZe,,t. T-2 Location: �n ✓1��fl11�-2 S` City _ ) D/`C N LJO Phone am a homeowner 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 City: Phone#: Insurance Co. Policy# Company name: Address City Phone# Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andtor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature --Date-I /c7— Print name &l fe b O1� Phone* 0' 7 �9—7 ?l� Official use only do not write in this area to be completed by city or town official' E]' Building Dept OCheck if immediate response is required Building Dept C] Licensing Board p Selectman's Office Contact person.- Phone#: 0 Health Department Other FORM WORKMAN'S COMPENSATION t Town of North Andover t4ORTH 0f%.20 ,6"9.y Building Department o 27 Charles Street North Andover Massachusetts 01845 2 ry (978) 688-9545 Fax (978) 688-9542 A. �SSACHUs�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and.a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in/at: /YORC:> ,o(/ S ,4�a i �r� f , ., �s�e��,_ 4 Lem i✓_�4 Facility location j I Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. i X.IORTH Town ' of _ 4 over _6A 0 ., N®. %re IL io =�- L A E Odove r Mass. COCMICKEWICK V > AORATED fk" S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System %4 THIS CERTIFIES THAT....... ...... ............................................ BU ILD ING INSPECTOR has permission to erect..... ... ....... .. . . . Foundation n..5..11- . "I Rough to be occupied as �' Rf rm w� 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. 44 S C PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUC O S ELECTRICAL INSPECTOR Rough .................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det.