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Miscellaneous - 59 BANNAN DRIVE 4/30/2018 (2)
DRIVE � 210/033 8.0-011.0-011 3-0000.0 i ,� I I I� I TOWN OF NORTH ANDOVER F kORTH q BUILDING DEPARTMENT ° <�``° do 1600 Osgood Street, Suite 2-36, North Andover Ma 01845 O ID NOTICE OF VIOLATION y * r e � �9SSACHU`'E��y Date: Address: Jr N 11 rl �v - Building 17 Zoning Bylaw 0 Stop Work Order Certificate of Inspections Electrical Plumbing Gas Violation observed: QCG 6 el Z)14 &lvdz j v Failure on your part to comply with this notice within 10 days may subject you to penalties prescribed by Massachusetts Law 780CMR or ghr Andover's Zon�law./I?base contact the Building Department for further information at 978-688-9545 inspector-,—,' Home Owner /�j� Contractor Location —5V&N A-1 ON No. Date . - TOWN OF NORTH ANDOVER 41 Certificate of Occupancy _ - s � Building/Frame Permit Fee $ 11 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 7]22.27101 r Ru'ddi4inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO• •J —1 Date Received Date Issued: & 1 _ ORTANT:A licant must com lete all items on this age LOCATION C / 4 / - Print PROPERTY(OWNER Print Mp NO:05 LPARCEL.6113 ZONING DISTRICT: Historic District yes n Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family Wd'dition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial ' ❑Repair, replacement ❑Assessory Bldg 11 Others: [IDemolition ❑ Other W_ell � lam ` Welands " atershed tOWDistrict ,r P a ,� ; 3 � i} -� DESCRIPTIO OF WORK TO BE PERFORMED: ✓� cs/' � . AX - - Identification Please Type or Print CIearly) Phone: OWNER: Name: / Address:�r CONTRACTOR Name: cd t /" ! Phone: 7 Address: / Supervisor's Construction License: �� 6- '75-j�S Exp. Date: /� J 2. 7 Ex Date: Home Improvement License: P• ARCHITECT/ENGINEER�� P� Phone:1�E %r. 44 Y VV Address: Reg. No. 5745�� FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. FEE: $_ Total Project Cost: $ J Check No.: 7a Receipt No.: 5Z �° NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ' � W Signature:ofiAgent/O,wner;.�::= _':- ° na ure ._ . n Plans Submitted Plans Waived ❑ Certified Plot PlanStamp ed Plans L� TYPE OF SEWERAGE DISPOSAL E Public Sewer ❑ Tanning[MassageBodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SEGTIONS FOR OFFIGE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED j PLANNING & DEVELOPMENT ❑ //�/ >> ='1 COMMENTS !+1�t I )-c��d� 1e�✓ �u cz i>'�� CONSERVATION Reviewed on 11 3 Signature COMMENTS 1 HEALTH Reviewed on Si nature Ile COMMENTS [ Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments .*Conservation Decision: Comments 'Water& Sewer onner-tionISignature&Date Driveway Permit II DPW Town]Engineer: Signature: Located 384 Osgood Street m FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMIV..IENTS Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 117,600.00 m $ - $ 1,411.20 Plumbing Fee $ 176.40 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 176.40 Total fees collected $ 1,864.00 59 Bannan Drive 431-14 on 11/13/2013 20x20 Addition -2 Story NORTH own of sAndover 0 to No. 4721., 14 , h , ver, Mass, zz A- COC NIC Ml WIC.t y� 7d A�RgTED S U BOARD OF HEALTH Food/Kitchen PERMIT T. LD` Septic System THIS CERTIFIES THAT .....: �d..%". �,Y /� .. 'le'�5���� BUILDING INSPECTOR ..... ..... ........ ......................................... G Foundation has permission to erect .......................... buildings on ...��.� .. .. !!��':'4'.'.. :r`. �F............................ > / � Rough to be occupied as k a. G .. .AGI . '*' cute — v2 '�`.``. . ......................................... chimney ................................................................................ provided that the person accepting this permit shall in every respect conforn to the terms of the application Final on file in this office, and to the provisions of the-Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ..... ..... .. ... ..... :.. .........:..................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 4 . TWOMEY & LEGSRE CONTRACTING INC . "Couldn't your home use a little TLC?" Specializing in residential additions 87 Belmont Street, North Andover, MA 01845 1-HC #136779 North Andover- 978.685.7447 Facsimile- 978.685.7446 CONTRACT 1. Date of Contract Signing: 2. List of Documents/Counterparts of this agreement: A. Contract B. Specifications/Proposal (See Exhibit B below) C. Drawing/Plan(see Exhibit C attached) D. Payment Schedule(see Exhibit D below) E. Limited Warranty(see Exhibit E below) F. General Notes (See Exhibit F below) 3. Parties to Contract: A. Contractor: Twomey&Legare Contracting, Inc. Shaun Twomey/Doug Legare Federal ID#20-3436110 Address: 87 Belmont Street,No. Andover, Ma 01845 Contractor Registration No.: 136779 B. Homeowner: Tom & Sandy Blackshaw 59 Bannon Drive North Andover Ma, 01845 978-975-4578 4. Description of work to be done and the materials to be used: See Specifications (Exhibit B) 5. Total amount agreed to be paid for work to be performed under the contract: 6. Time schedule of payment to be made under the contract, finance charges for late fees (if any)*: See Payment Schedule(Exhibit D) Owner Initials: -J6 Page 1 of 12 Contractor Initials: /� i *Any deposit required to be paid in advance of the start of the work shall not exceed one third of the total contract price or actual cost of any material or equipment of a specific or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed_ to the satisfaction of all parties. 7. A. Date work is scheduled to begin: (see No. 14 below) B. Date work is scheduled to be substantially completed: (see No. 14 below) 8. Notice: A. All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor and/or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation 10 Park Plaza, Suite 5170 Boston, MA 02116 (617) 973-8700 B. For contractor's registration number, see first page. C. Homeowners have a three (3)day cancellation right under MGL Ch. 93 § 48; MGL Ch. 140D § 10; or MGL Ch. 255D § 14 as may be applicable. See attached Notice of Cancellation. j D. For homeowner's warranty rights, see 780 CMR R6 and MGL Ch. 142A. 9. There is no lien or security interest on the residence as a consequence of this contract. 10. Permit Notice: A. The following permits will be required in connection with the work to be performed on your property: Building—Electrical—Plumbing B. It is the obligation of the contractor to obtain these permits as the Homeowner's agent. C. Any homeowner who secures their own construction-related permits or deals with unregistered contractors shall be excluded from access to the guarantee fund. i Owner Initials:,� �� Page 2 of 12 Contractor Initials: b y i 11. Contractor reserves the right, if he deems himself to be insecure to require, asa prerequisite to continue work,that the balance of funds due under the terms of the contract,which are in possession of the owner,be placed in a joint escrow account requiring the signatures of the contractor and the homeowner, for withdrawal. 12. The parties agree that no work shall begin prior to the signing of the contract, transmittal to the owner a copy of the contract and the expiration of any applicable rescission period. 13. Arbitration Clause: The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration as provided in MGL Ch. 142A. 14. Other Provisions: A. Commencement and Completion of Work-Contractor agrees to proceed diligently with the agreed upon work, commencing promptly, following: • The completion of the Title V installation and certification of compliance by the town and/or; • Issuance of a building permit by the town. B. Final payment shall be upon the satisfaction of the homeowner. The parties agree that the issuance of a certificate of occupancy and/or final inspection shall be the objective standard that the contract has been complete and the parties satisfied. Any final punch list items shall be reduced to writing,with an estimated date for completion. The parties agree that no escrow will be held for punch list items. C. Insurance—Contractor agrees to provide evidence of liability,workers compensation and other risk insurance. Owner agrees to provide copy of hazard insurance as is required by contractor to coordinate policies. Owner Signature: Date: /O /l0 020%3 Owner Signature: Date: Contractor Signature: Date: Owner Initials: Page 3 of 12 Contractor Initials: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES /0 ;W-3 Owner Date Owner Date Con actor 14ate Contractor Date Owner Initials: Page 4 of 12 Contractor Initials: TWOMEY & LEG RE CONTRACTING INC . "Couldn't your home use a little TLC?" Specializing in residential additions 87 Belmont Street, North Andover, MA 01845 HIC #136779 North Andover- 978.685.7447 Facsimile- 978.685.7446 August 26, 2013 EXHIBIT B Proposal/Specification Homeowner: Contractor: Twomey&Legare Contracting, Inc. Tom&Sandy Blackshaw 87 Belmont Street 59 Bannon Drive North Andover,MA 01845 North Andover,MA 01845 978-975-4578 Second revision 9/30/13 New Addition Fist revision September 11,2013 Thank you for the opportunity to quote the following project. The Twomey&Legare Contracting, Inc.price is based on our discussion on August 6,2013 concerning your project at the above captioned address. The following is a description of work to be completed as discussed: 20 X 20 Addition, with frost wall foundation on back of main house. 2—finished floors with Bath and 5 X 20 Deck. These specs are based on conversation and walk through with the owner. The preliminary plans and final plans supplied by us will match these specifications. 1. Contractor to contact dig safe prior to digging. 2. Excavate as required for frost wall foundation. With a cut through from old basement, to new room. Includes perimeter drain with pump. 3. Demo,Remove deck windows doors and siding, as needed for new rooms. 4. Structure to be built according to plans provided by contractor in accordance with theses spec. Doorway in kitchen to be sheet roock opening, and slider area to be approximately, a 10-8 sheet rock opening. 5. Owner to supply certified plot plan. Any additional as-built or plot plans by owner. Owner Initials: 0& Proposal/Specifications Contractor Initials: Page 1 of 3 All septic, landscaping and extention of driveway by owner. 6. Floor joist to plan. Walls to be 2 x 6 construction. 7. Floor sheathing to be 3/4 Advantec plywood. 8. Wall sheathing to be '/�OSB. 9. Roof sheathing to be 5/8 fir plywood. 10. Roofing to be GAF shingles. Areas to be roofed,Main house, addition and roof line (See Allowance page) 11. Siding on addition,match existing on main house. 12. Match existing trim boards and wrap. 13. Insulate addition to code. 14. Drywall to be_%2 inch blue board plaster, with smooth walls and textured ceilings. 15. Interior trim to match existing as close as possible. 16.Painting. All painting by owner. 17. Disposal of all debris by contractor. 18. Additional spec, on completion of construction plans. 19. Any landscape or shrub replacement by owner. Contractor to spread existing loam to be racked and seeded by owner. 20. All permits and inspections by contractor. Sprinkler system-none A/C-none Pleating 1. Add 2 new zones of heat off existing boiler. (See Allowance page) Plumbing 1. Run new water and sewer lines for new bath,Run septic line to exterior wall to be tied into main by septic company. 2. Plumb for single bowl sink. 3. Shower&toilet. Shower to be tiled shower stall. 4. Run gas lines for two fire places. Electrical 1. Upgrade electrical to a 200 Amp service. 2. Wire addition to code. 3. Ceiling fan/light fixtures. by owner. 4. 1-closet lights by contractor. 5. 1-vanity light by owner. 6. 2-phone 2-cable locations. 7. 2- exterior GFI plugs. 8. Smoke detector to be brought to code in main house also. 9. Plugs to code. Switches per light location. 10. Bath fan light combo. Fixture by contractor. 11. 2-Dimmer switch. 12. 6-recessed cans. 13. Exterior, 1 -flood light,2-door lights. Fixture by owner. Owner Initials: 0 Proposal/Specifications Contractor Initials: Page 2 of 3 r _ 13. All light fixtures by owner, list of fixtures needed will be given to owner. Bath Fixtures 1 —Toilet with seat. 1 —Vanity with top/sink and faucet. 1 —Shower valve for tiled unit. (See Allowance page) Fire Places 2—Zero clearance fire places. (See Allowance Page) Windows Anderson Series 200 (See Allowance page) Interior doors 3- single, 6 panel solid core masonite door units with knobs. Exterior doors 2 - 15 light Thurma Tru fiberglass insulated door with knob and deadbolt. 2- 2 Larson pull screen doors. 1-Double active, Thurma Tru french door unit. With knobs and Larson pull screen kit. Flooring Upper floor to be Maple prefmished,match existing as close as possible Lower level floor bedroom to be carpet. (See Allowance page) Tile Tile floor bath floor and shower walls. (See Allowance page) Contractor Signature: Date: Homeowner Signature: �L/� Date: vot 3 Owner Initials: Proposal/Specifications Contractor Initials: Page 3 of 3 TWOMEY & LEGARE: CONTRACTING INC . "Couldn't your home use a little TLC?" Specializing in residential additions 87 Belmont Street, North Andover, MA 01845 HIC #136779 North Andover- 978.685.7447 Facsimile- 978.685.7446 EXHIIBIT D Job Total & Payment Schedule Payment No. Amount Due Date Received Remaining Balance JOB TOTAL $117,600.00 1 st on si gnmg $15,000.00 On Signing `Z> 102,600.00 2nd payment $105000.00 completion/Excavation $ 921600.00 3rd payment $15,000.00 Completion of foundation $ 779600.00 4th payment $17,000.00 Completion of roof $ 60,600.00 5th payment $27,000.00 Completion of mechanicals $ 331600.00 6th payment $20,000.00 Completion of drywall $ 131600.00 7th payment $109000.00 Completion of finish work $ 35600.00 8th payment $3,600.00 Final Inspection by Town $ - Based on owner completing rails Thank you for considering TWOMEY&LEGARE CONTRACTING fop your project. Please feel free to call with any questions or concerns. Homeowner Signature Date /0 Owner Initials: Page 6 of 12 Contractor Initials: I dA. am/ T O EY & LEGARE CONTRACTING INC . "Couldn't your home use a little TLC?" Specializing in residential additions 87 Belmont Street, North Andover, MA 01845 HIC #136779 North Andover- 978.685.7447 ALLOWANCE PAGE Owner: Tom& Sandy Blackshaw Property Address: 59 Bannon Drive North Andover,Ma Description Amount 1. Bath fixtures $2,000.00 2 Tile& Grout $800.00 3. Gutters $400.00 4. All Painting By owner 5. Windows $3,200.00 6.Doors Interior&Exterior To specification page ! 7. Heat $4,500.00 8. 2 -Zero clearance fire place,material and labor $5,600.00 9.Hard wood flooring_ $2,900.00 10. Carpet in lower level $1,800.00 i 11.Roof on Main house $5.400.00 Extra, Save $800.00 if garage is excavated and poured at the same time. Foundation for a new garage. (This price is good till December 29, 2013) Excavate I pour foundation/stone inside of foundation for a pitched slab. Compact/pour slab/backfill and grade existing leftover loam. Material &Labor, $10,450.00 Owner Initials: Allowance Page Contractor Initials: Page 1 of 1 'Kigh.tifax C3-1 9/19/2013 5 :15:55 AM PAGE 2/00.2 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 091912011 TWS*GERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIRCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND-OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE O PRODUCE D THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the. terms and conditions.of the policy,certain policies may require and endorsement A statement an this certificate does not confer rights to the = certificate holder in lieu of such endorsement(s). PRODUCER CONTACT. ' NAME: DOHERTY INS:AGENCY INC PHONE FAX PO BOX I985 (A/C,No,ExQ: (AIC,.No): E-�L ANDOVER,MA 01810 ADDRESS: 22 VVIR INSURER(S)AFFORDING COVERAGE NAIC#. INSURED INSURER A: TRAVELERS INDEMN TY COMPANY OF AMERICA TWOMEY&LEGARE CONTRACTING INC INSURER B: INSURER C: PO BOX JE)G INSURER D: INSURER E NORTH ANDOVER,MA 01&35 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 6SUREDNA-rM FORII-EPOUCYPEPoOD S TEQ AND117 t Ti•�T MJY REOIIRE]t1 M,TEFM OR COMCMON CFANYCONTRACr OR OTHER DOCtRMff WrTH FMPECTTOMCH THS CERnnrATE M4Y BE ISSUED OR MAY PERTAK TW INSURANCE. AFFORDED BYTWPOUgESDESCRIBEDHEREMIS,SUBJECTTOALLTHETFT4EXCkUSICIGPMCQPDMCNSOFSUCH POLICIES LI ITSSidNNMAYHAVEBtOTIREOUCEDBY PAIDCLAIMS HSR ADD SUB POUCY ffP DATE: POLICY DIPQATE LTR TYPE OF I�IRANCE L R POLICYNIINBER (Md.MYYYY) (MUADDIYYYY) LIMPS GENERAL LIABILITY EACH OCCURRENCE $ PCOMMERCIAL GENERAL LIABILITY ANLAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) ED EXP(Anyone person) $" ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY E]PROJECT❑LOC" RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIM-MADE AGGREGATE $ DEDUCTIBLE $. RETENTION $ $ WORKER'S COMPENSATION AND. WC STATUTORY OTHER EMPLOYERS LIABILITY YIN UES-0290M99413 09!1&2013 09/18(_2014 I LIMITS ANY PROPERITOWPARTNEBIB CCUTIVE a N/A E.L EACH ACCIDENT' $ 500.000 OFRCEPA43VBER DCCUJDED? (INada<arycrNH) E.L.DISEASE-EA EMPLOYEE $ 500,000 . IIyes,RPnCdescribe(aide E.L.DISEASE-POLICY LIMIT $ DESCRPTICN OF OPEFWTIOt`5 hda,.. 500.000. DESCRIPTION OF OPERATIONS/LOCATiONSNEMCLESIRESTRIC 1ONS/SPECIAL ITEMS' THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP.COVERAGE CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE.DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENT 31V£ i a NORTH ANDOVER,MA 01845 ACORD 25(2010105): The ACORD.name and logo-are registered marks of ACORL 1988-2010 ACORD.CORPORATION. All rights`resenred: JJJN-420-2013 THU 04.06 PM FAX NO. 9784750303 P. 14/17 Client#:13298 T QMEYB ACaRD., CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DD/YYYY) PRODUCER 06/20/2013 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Doherty insurance Agency,Inc. ONLY A 40 CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.BOX 1985 HOLDS .THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 21 Elm Street ALTER HE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover,MA 01610 INSURER AFFORDING COVERAGE INSURED NAIC# INSURER A: rbella Protection Ins Company Twomey S,Legere Contracting,Inc. PO Box 366 INSURER B: North Andover,MA 01845 INSURER C: INSURER D: INSUHER E.- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AE OVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR TE MAY BE ISSUED OR MAY PERTAIN. HE INSURANCE AFFORDED PY E POTION OF ANY LICES DESCRIBED CT OR OTHER HEREIN IS SUBJECT O AWITH RE CL THE TERMS.T TO WHICH EXCLUSIONS AAND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S TYPE OF INSURANCEPOUGY NUMBER U Y EFFE T E PO I N LIMITS A GENERAL LIABILITY 8500043255 46/22/13 0$/22114 EACH OCCURRENCE $1,00(),000 X GOM,MERCIALGENERAL LIAg417Y OAMA% ORENTED $100 OOD CLAIMS N.AOB a OCCUR MED EXP(Any oar,Person) 55,000 PERSONAL BAOV INJURY 11,000,000 GENERAL AGGREGATE S2,000,000 GFN'LAGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OPAGG 52000000 X POLICY 7 PRO- LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT 5 (EP sCCdIdM) ALL OWN-0 AUTOS SCHEOULEDAUTOS BODILYINJURY S {Par Person) HIRED AUTOS NON OWNED AUTOS BODILY INJURY S (Per accident) PROPERTY DAMAGE 5 (Per ncgnum) GARAGEUABILITY ALA 0ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACG 5 AUTO ONLY: AGO 3 EXCESSrUMBRELLA UAOIUTY EACH OCCURR=NCE g OCCUR CLAIMS MADE AGGREGATE F.5 DEDUCTIBLE S RETENTION 5 WORKERS COMPENSATION AND WC STATU5 - OTH- EMPLOYERS•LIABIUTY ANY PROPRIETORIPARTNERf--EXECUTIVE E.L.EACH ACCIDENT S OFFICERRAEMBER EXCLUDED? If yes.Oes"Ounddr F--L DISEASE-EA EMPLOYEE S SPECIAL PROVISIONS twow E.L.OIS@ASF,-POLICY LIMIT Is OTHER DESCRIPTION OFOPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PF OVISION5 Covering operations usual to Twomey Legare Contracting,Inc... CERTIFICATE HOLDER CANCELLA ION 10 0a S for Non-Pa ment SHOULD ANY O THE ABOVE DESCRIBED POUCIFS Se CANCELLED BEFORE THE EXPIRATION DATE THERE-OF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SHALL IMPOSQ NO OB MATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATI FS. AUTHORIZED R ESENT Cf ACORO 25(2D01108)1 of 2 #S29374/M29371 DML 0-KC-ORD CO TION 1988 n .r lit�s.ichusett - }eit.te iancnt iif Pul)lic:S tlfo B�i.ittl-Of Buildin;-=Rc<(ulatiftns"ant] Standards ' /+ ls.CJtrt�Lyyii�n �.�U er visor Kicens 67560e C� l , _ Lt�� - , SHAUN'M TWOMEY 61 PAT ROIT ST 'N ANDOVER,A%01 E*ra` n: 10/25/2013 t'ut�a�ironer Tru 4913 1.. �s 11M Massachusetts -Department of Public Safety hoard o7$uiltiin Roc relations rd Sta, dat'da Construction Sujwrnisor :cense: CS055108; DOUGLAS J LEGARE 79 GARY AVE HAVERHILL MA 01830 Cor,rnisssiic"nne^ 09/02/2014 -- �r�ana»zanttaettll�.c�r';��aslac�risaGl` ; Office of Consumer Affairs&Business Regulation _ i NO f)ME IMPROVEMENT CONTRACTOR Type: "Wegistratron 136779 —Lxpiratron 8/26!2014: Partnership TWOMEY+LEGARE CONTRACTING INC. SHAWN TWOMEY 87 BELMONT ST. N_ANDOVER,MA 01845 - Undersecretary I L � '�- chusetts-Department of Public Safety Massa ulations and Standards Board of s Building RegcrN icor 1 Construction SuP' J CS-(167560 License: ter. _ SgpUN M TWOW, j'4j 61 PA IROITsT 018NOVERN1tT Expiration 1012512015 Commissioner I The Commonwealth of Massachusetts Department of Indv_strial Accidents 7 Office ofinvestigwtions . 600 Washington Street Boston, MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f Please Print T-e-ejbly Name (Business/Organization/Individual): J CtA"a"I 7 C� � �' �o % tZ� `r �/ ` �ri%C Address: 21� � 7-: City/State/Zip: IV IMS Phone#: Are ypu an employer? Check the-appropriate box: Type of project(required): 1.ETI am a employer with � 4. ❑ I am a general contractor and I 6. F-1 New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- lasted on the attached sheet 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. (] D olition workingfor me in an capacity. .-kers' comp.insurance. y P ty *9. Building addition [No workers'.comp.insurance 5. We are a corporation and its • r required.] officers have exercised their 10•0 Electrical repairs or additions. 3.❑ I am a homeowner doing aL work right of exemption per MGL 11.0 Plumbing repairs 'or additions myself. [No workers' comp= c. 152, §1(4), and we have no 12.M Roofsepairs 1 insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required] *Any applicant that checks box ml must also fill out the section below showingltheir 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 their workers'comp.policy information. I am a:employer that is providing workers'compensation insurance for nny employees. Below is the.policy and job.site information. .Insurance Comp any Name: .-FIZAVCLerg , is^f—f Com' Policy#or Self-ins.Lic.#: Expiration Date:_ Job Site Address: �7a/3/)G0 d /`%✓�C.. City/State/Zip: j1,t,/ 61il 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 againff i_he violator-.-Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.-hr insurance cover�gti.verification. I do hereby certify urn er the pains and penalties of perjury that the information provided above is true and correct- Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town ofjfciaL City or Town: Permit/License Issuing Authority(circle one): I-Board of Health 2.Building Department 3.City/Town Clerk 4-Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: k Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq, ft:: I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$10041000 fine r NOTES and DATA— For department use ® Notified for pickup - Date I Doc:.Buildiug Permit Revised 2008 I Building Department ` The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits q/Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C.,And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed interior;Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign offifrom Fire Department prior to 'issuance of Bldg Permit Addition Or Decks ZE� uilding Permit Application Certified - _ Surveyed Plot Flan Workers Comp Affidavit It hoto Copy of H.I.C. And C.S.L.'Licenses ❑ Copy Of Contract Floor/Crossection/Elevation Plan Of Proposed Work-With Sprinkler Plan And H .draulic Calculations (If Applicable) a ss check Energy Compliance Report (if Applicable)- . ngineering Affidavits for Engineered products RIOT : All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Pied Proposed Plot Pian ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to include Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ' ❑ Engineering Affidavits for Engineered products . OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit ' all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals rt the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording is be submitted with the building application Doc: Doo.Building permit Revised 2008m! Date.:12-1!.43...... 10J33 "SRT TOWN OF NORTH ANDOVER * PERMIT FOR PLUMBING $3ACHUSE This certifies that..... ?.t•� !... . ............................................................... has permission to perform......., CTL+ z ...................................................... plumbing in the building of............................................................................................. at..........�g. K ......... ............ ....�.:........ North Andover, Mass. /, Fee�'f.. r.`�.1)Lic. No. /.�`�� oy ............. ..................................................... V PLUMBING INSPECTOR Check# (� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r. W CITY ti MA DATE 2 o PERMtT ` 11 JOBSITE ADDRESS OWNER'S NAMEI %cM 13 traka(M(. P OWNER ADDRESS S &Ngofit ___jTEL127_1_2tZ- 4 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ❑ RESIDENTIALPRINT � CLEARLY NEW: RENOVATION:® REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOOR- 8SM 1 2 1 3 4 5 1 6 1 7 8 9 10 11 12 13 14 BATHTUB - CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR _.._ KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a hermit :mwn rtce PoficY or 8s wbstantial equivaW*which taus the requirements of MGL Ch.142. YES[ NO [� IF YOU CHECKED YES,PLEASE!)INDICATE THE TYPE OF COVERAGE BY CHECKSIG THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY ❑ BOND❑ OWNER'S INSURANCE WAIVER:I am aware that the licettsee does not hm the kmram coverage requW by Chapter!42 of the Massachusetts Get>eral Lars,and that mfr squan on this pwoapplicom U ,this regwrenolt. CHECK ONE ONLY: OWNER ❑ AGENT SIGNATURE OF OWNER OR AGENT are true ao�uaee gest my knowledge i heratry oerdfy that as of the de2aAs and Wdb mat m I Neve submitted or entered re�rding applicatlor► and that aN pkmft 9 work and Ins ne performed under the permit issued fbr this appiluftn will be in own wl Pertinent provision of the Massachusetts State Pt wtft Code and C*br 142 of the General Laws. 7 77 PLUMBER'S NAME Steven Carr LICENSE# SMATURE MP( JP® CORPORATION®#=PARTNERSHIP E]#=LLC❑# SOLEPROP COMPANY NAME CSPC Plumbbky S Hem ADDRESS 12 0mcord SL STATE MA_ ZIP 01844 TEL 978.815936 Y CIT —____ �..._: FAX 978.208-1081 CELL 978-815.3936 EMAIL �t J - - r , r I i r � i i . wr f , 1 f r•i C by1 e J Date....... ........... TOWN OF NORTH ANDOVER ERMIT FOW-kG Q AS'IN.STALLATION- 88+cHU This certifies that . ........................................................ has permission for gas installation ... ............................. inthe buildings of................................................................................................................... at.... ......................... North Andover,Mass. Fee-&.�— ... Lic. No. . ..... ............................. I /ZA9,&) GAS INSPEC OR Check# 9052. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK WjCITY jj ��rtl_ oa,�� ✓l MA DATEA3 /3_ PERMIT# 10� JOBSITE ADDRESS r��r c�aaJ �~ �. �_ OWNER'S NAME ��-r stc5 �o.V� p„ GOWNER ADDRESS q nyv 1 �?- . TECL.�..*Jff G�7 F Ca TYPE OR OCCUPANCY TYPE COMMERCIAL( EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW.JV RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - COOK STOVE DIRECT VENT HEATER DRYER i FIREPLACE FRYOLATOR F__ - r FURNACE :- GENERATOR ,GRILLE INFRARED HEATER — fLA60RATORYCOCKS MAKEUP AIR UNIT OVEN _. POOL HEATER s ROOM 1 SPACE HEATER IIS ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER , ,o INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES D NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I OTHER TYPE INDEMNITY [j BOND OWNER'S INSURANCE WAIVER:i am aware that the licensee does not have the insurance coverage requhW by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. l CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and to the best of my knowledge and that all plumbing work and installation:performed under the permit issued for this application will be in complia all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASATTER NAMESteven C ff_ LICENSE# 15366 r SIGNATURE MP D, MGF 0 JP-1 JGF WI CORPORATION r:#Lr--=PARTNERSHIP LLC �# so,l iop COMPANY NAME:'LSPC Plumbing BpHeati �� ADDRESS 112 Concord St CITY STATE MA ZIP TEL�9! 78-81, -�m.�R�_.�.....,__ # _ 5-3936 FAX 918-208-1081 CELL 978-815-3936 EMAIL i sW@venaon net „# :�- .. � ��� � � s �. :� 1 J i i ' � j �. .. i - r1 l � � � � � � � .� } �a � � � ' i � r � � � G r .. � �'�''� � ��� ��' ��' _`�-�-�;� `�.c-, tied�`1 �/�r'1 -�� '` %'1 �`��!� � x COMM®Nwi/ 9F SA�HiISETTS i PLL'MQ o • LI; CRE RS ANLi GASFITTERS IssuEsArs A MASTER PLu ABOVE LICENSE TO: .MBER 5 VE- "N CARR 1= ONC,OF?D ST MF T i lE P1 0184 }e366 b " 05/01/14 • y� S� Vir 12 7o� - 3'� 3 G,/ r77/ y � d f IPX�71&IV6 Ac Rc� CERTIFICATE OF LIABILITY INSURANCE THIS CEDzTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO ROM UPON TETE CERTIFICATE HOLDER.THIS y CERTIFICATE DOES NOT AFFIRMATIVELY OR NEt3ATIVELY AMEND, 1EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: a the cor8llcate hot er Is an ADDITIONAL INSURED,the pollaypea)must be endorsed. if SUBROGATION 16 WAIVED.subject to the terms and oonditim of the polity.certain policies may require an endorsement A statement on this cordficato does not confer rights to the twillicate holder In lieu of sue ondcrsementts. PaowDElt NA Edward W;iays Fiat's Insurance Agency,Inc, (978)8963182 (878AS9 4426 36 Hawthome Ave. ADRm. nsutanc9@camcast.net Methuen.Mia.018" NKUWMI Deft COYOtA a NNe• MMA!'NO"k&Dedham Mutual Fire kwirance Company Steven Carr ' DSA SPC Plumbing and Heat 12 Concord SL woo"a Methuen, tole 01844 COVERAGE:-.S CERTIFICATE NUMBER: REVISION NUMBER: THIS,IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASQAIE FOR THE POLICY PEWD INDICATED: NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUWN T WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE;tSStI W OR MAY PE rAlN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIU.LIMITS SHOWN MAY HAVE SM REDUCED BY PAID CLAN & WSRILC TYPE OFNwift NCE cy LAM, 021004 LVMM 00CUMENCE 6 1,000.000. x COM►a RCS{.Gomm LPMUTY PRE E E5>tERTf?6 i_ A FMO52M 3-28—• 3 &NNI 2,000.000. 3t28-14. GENERAL Awft-GATE s 2,000.000. GBNL AGGREGATE umrr APPLIES PER; PR oss-COMMP Atra $ a.�. 71 POUCY LOC : AUfOMOBItF LtAell.rrr IJMI ANYA= a0V%YDuum(ft Pwsm) i •••- am D SOMYKAMOWN111"M t Atm $ MMAVMS X03 S ummum-"u" ODOUR EACH s AGGREGATE YWRKERbCOrrPENdATlON �' AND VOLOYO'L"SITY YINIEC tr+ rMr.a.m� t EAeM �P 1.000,000. A MYPN E�O�U0 07 L::.I MIA WE103394A 12-18-1 n wdw MP _ 1.000. 0. aFo�rra blew a?L UMR s 7,000,000. DEaCRIP'nON OF orfrRAT1oN0I rdOGATlWrS r YEfeGLEa(Awrh AGORD 101,AOtAllanN MrAgArt Sdwdute:N mar.�P�b rquweq V4hVeta Management Co.,LLC..Rockmers Radlyt Assoriales L.P.,and heir affiliated corporation.companies.Iaitnership,part om.0".emp . repreaentatives,olficars,and directors as additlonal incu s. -CERTIFICATE HOLDER CANCELLATION_ Town of North Andover MMULD ANY OP Y"4AWVE MKRISED POLICIES BE CANCE;Lam Btu THE EXPIRATION DATE: nOtEOF, MWICE WILL BE 08ivE7= It Building Dept ACCORONICE WITH THE POLICY PROVISO" 1606 Osgood St w. - Building 20, suite 2-36 AunR> TavE Nor.th.Andover r Ma 01845 4j j "!y ACORD 25(2010105) 988.2010 ACORD C RPORATION. Ail rights reserved. The ACORD name and logo are registered marks of ACORD t 1 L moi_{ ♦ ... - - _ .. � r r _ _ I ! 1 I I I 1 E e v I t�+ .. - J�n � • '£w 1 �- .ice � .�. - - - - � — _. � _ ^ r. ... .� f The Commonwealth of Massachusetts Department of Industrial Accidents lip Office of Investigations 600 Mashington Street Boston,MA 02111 wwtv.ntas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Al)nlicant Information___ Please Print Legibly Name(Businesstorganizatiom4Wividuai): SPG ?t soh 3 tw t- # uM4� Address: 12 'Gln coma Sr City/State2ip: hen+yLeA OA 0 t yti Phone#: 7�3-�;I G ' "AQ . Are you an employer?Check the appropriate box: Type of project(required): 1. I am a•employer with _ 4. 0 I am a general contractor and I employees(Ml arid/or part-time).* have hired the sub-contractors b' 0 New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t ?• ❑ Remodeling ship and have no employees These sub-contractors Dave 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. [] Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its - 10❑ Electrical r airs or additions required.] officers have exercised their eP 3.❑ I am a bomeowne'r doing all work right of exemption per MGL i 1.❑ Plumbing repairs or additions myself'.[No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance moue&]t employees. (No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must at=Gil out the section below showing their workers"compensation policy infornution: t Fiotnoownen who subntft this affidavit indicating they are doing all work and then hire outside contractors must submit a new&Mdavit indicating suck tConhaciors clot check this box must attached an additional sheet showing the name of the sub-matractors and their worker:'comp policy information. I am an employer that is prot4ding workers'compensation Insurance for my employees Below!s the policy and,fob stW dtrformatlon. Insurance Company Name: Policy#or Self-ins. Lie.#: i;rt C14A — Expiration Date: ate: Job Site Address:_ 7 i nrdnlAUJ2 v vd . I1City/StatelZip:_ r _Z" 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 orMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 aud/or one year imprisonment,as well as civil penalties in the form ora STOP WORK ORDER and a Cue orup to 5250.00 a day gainst the violator. Be advised that a copy orchis statement may be rorwarded to the Office of Investigations of the for insurance coverage verification. I do hereby certify t d r the pains and penalties of pe'rjttrp that the btfornnation pr orided above is true and correct a I2 Date: I Oficial use only. Do not nvr in this area,to be completed by city ortotvit officiaL City or Town: Permit/Llcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector S.Plumbing inspector 6.Other Contact Person: Phone#: r � i, //yDate......./ ........ pORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that .......... . ........ ................................................... has permission to perform .......4. wiring in the building of.......6MLO.P.4........................................................ at *,*"�*�l******"*****�*,,J/,7".*"***"/c/.........................No Andover,Mass. Fee..........A...........Lic.No. 1.,.-14.............. ....... . .......... ELECTRIC INSPECTOR Check# 3� 77 12 10 2 -�` [�ommoreweatth o� a�ac Official Use Only / Permit No. �lJePartsneret o�..fire JerUicea � I Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONST ev.1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /A I City or Town-of: N4R_7V AxicVutv2 To the Inspe orc of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) , 0 3 Owner or TenantTelephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 9 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 16F0 Amps l2-4)/ 2Ci0 Volts Overhead JK Undgrd❑ No.of Meters New Service 200 Amps /20 / 2-W Volts Overhead 9. Undgrd ❑ No.of Meters l �— Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ���� �,�iT/0KJ w/ ✓tC�� �i�Ga,�9QF Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires /Q No.of CeiL-Susp.(Paddle)Fans No.of Total Transformers KVA .. No.of Luminaire Outlets 8 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o.o mergency Lighting j grud. rnd. BatteKy Units No.of Receptacle Outlets 22— No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and I Z Initiating Devices No.of Ranges No.of Air Cond. TotalNo.of Alerting Devices •Tons g Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: _._.. —_._...__..._...._.__..._............._. Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* Ballasts No.of Devices or uivalent Heaters No.of Water KW No.of No.as Data Wiring: Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER. S: Attach additional detail if desired,or as required by the Inspector of Wires. S Estimated Value of Electrical Work: (When required by municipal policy.) �( ` Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless 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 M BOND ❑ OTHER ❑ (Specify:) �. I certify,under the pains andl enalties of perjury,that the information on this application is true and complete. FIRM NAME: DA\1 I p E L E C T R i CA L_ GDN Tib IN _LC LIC.NO.: Licensee: D A\1 t t>, 4466 4i2 Signature LIC.NO.: 111 Cl b 3 afapplicable,enter"exempt"in the license number line_) fLI Bus.Tel.No.:J 18'b62-b lw62 Address: �-Z Dit L M ON`r" t' iiioR 1�N17�it>r 1�1 I `{`J Alt.Tel.No.-J'1i^ `.375-a:- 5q *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. � " 177 �a n�e �; PI�7 i =' Print l=oan The Commonwwea kh©,�'Hamchrasdi officeo. laww9a near 1 COAgraWS(M4Sake IN ----_=- Bailor X4 02114-2017 Workers'C=Wmafiola Usarmce Affdavit:ceders/Contractors Uectlra /P1=bers Dbmut Information Please Print Legibly NaMe(Business(OcgaaizatioaltndMdual}: DAVID ELECTCiICALCON RACfINGLLC Address_ 87 BE LMONT ST gj y/Sb&c/ZjW NOR-fH ANDOVER NIA_01845 phMe g- 978-1;82-6262 Are you a8 .Cbe&the appropriate bvsc rojed(� L0 I am a cmphU awM 7 4- E]I am a genead conttacto r and I y�e Tj s(finamiierput4ier have Rued the moots 6. New conArnefion 201 amasniepropictararpaarner listcdontue 7 [ gemdermg Shipandh"C nnempioyees These Sab-coub2chm have 8- Demolffin fnrre iia auiy c employees and have worker w0 comp comp- 9 []EWilm- gadiffifion rcc a ed-1 5- 10e:area cmVurafion and its 10-0 Electdcd repairs oradMons 3_[j I am abomemmerdoingaffwa& °$eshave exermsedtheir 1I-[]PhwdgzC rdiM or moss romp- 'W 0fm eUW60n per MGL h1sunaammregtsrtj T e-152,NO),andwehaveno, employ es-[No worluets' 13-0 Oslter cam¢insurance rcquirc&] sAuY2Wkutd tdmksbox;nmtsstatsDfmoutthesecfiDnhelovs sht I Houmuncra who sutbsitthis aWdaVit- Phi ar_ 'Co�chotstlntdraktiBsbox must at d� Mme s�amwafWaystm gsnm mPm fft33reeOO° �d�a� orrmttl�recafifics Imtre �P aey mastpsovided=madras congP P01mvnumb,, d am as eawleyer one isprosi&Mguavrleeis'cVMpWffM W mP�1� Below is ttrepo rmtijabsile Insurance Company Name: THE HARTFORD PoIicy#or Self-ins.Lir& 08 WFC 018293 Exph-atior Date: MARCH 1,201gL Iob Site Address: ,!1!k< City/StatelZip: Attadt a copy of the warkem'c0mpess240n poky dedaration page(Aowing the PONcY number and expiration date). Faffure to sectne coveaage as required under Section 25A of M€L c.152 can leadto the- fine up to$1,500-00 and/or one- asitian of I penalties o€a one-yew�as wen as c�pemal#ies in the farm of a STOP WORD ORDER and a fine UP to$250.00 a day agaiQstthe vioItttor_ Be advisedfu&acopy offhis stateutettmay he forwarded to the Office of eve aas of the DIA for" coves verification. Ida herrbp - _ �� re sZmeand correct phone ��R � eial�cnrert;�Iie �y�orfttsveso� City er?ewn: IkSaiag y{circle en* 6- of$eat 2. 3 C tyll' n Deck Ei c 5.Pi ng Iaspedar Phone#- -__ i a COMMONWEALTH OF MASSACHUSETTS ,? r e 'o o r a BOARD F ELECTRICIANS ISSUES THE FOLLOWING LICENSE ` AWED �1OURN.EYMAN ,;ELEC,TR I,C I AN ¢' .� �. DENN.).5 B BOMBARD"�' } ,• I�.::; is 60 CORK, ST N it RHA LL MA 01830 2108 f 13082 07/3 /16 39151.. - es Date.............3....,::P................. 44 Of NORTH .tw 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SAcmU This certifies that .... 6...... has permission to perform ........ ... .......................................... wiring in the building of....7� !.... ......... ..........P.f. at.................. .............. .North Andover,Mass. Fee..... Lic.No......... ELEcrRicALINSPECTOR/ Check # 5676 � DFPARTA�IVTOFPLIBLICSAFEfY Petntit No. 7� BOARDOFF7REPREVE,,YI70NAEGULATIOAN527CNR12.00 Occupancy&Fees Checked UV :PPtft'A77( NFOR POW TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 �O (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) '` Owner or Tenant a n Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building 7,0S/ C e Utility Authorization No. Existing Service Amps� Volts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground Q No.of Meters -- Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ///' No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total TVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and ound No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Air Cond. Total FIRE ALARMS No.of Zones No.of Ranges Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Locala Municipal Other Connections No.of Water Heaters KW No.of No.of signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP t OTHER K II�IY'ilZOr(.plH'ci�plD'Suil�$�1I1e1�HilB1lSC)�1SA�S�La�YS M ItmeaamatLabifityhm==PbbL,Yni&%CarOftopwj&mCoAWcrilssIf ltialegrivalat YES El NO E3 Ihmesthiledvdidptot£ofsameba ftOffi YES r7 Ifjmhmedm*edYFS,pfea mk*thetypeofwvwWbydakirIgte rCr BOND p GlHER p (Pk= EViafimDaft EtmskdVaiVdT d icalWdk$ WcrkoShalt Final Stgtedulxier�ie l J/ FIRMNAME /i GI/��� (TGZ�7 /_ l ✓'/G A7 Lioatsee �//'l- �_� �TQ•"���. � �,,,� L'oer�eNo /�/�i� BISQIeSSTd.Na 7�78'��r�` 706� Add= i n2� li �� -s� AILTe0h OWNER'SNSURANCEWANER;IanmmlhattheLioa>sedwsul theinslaa�oeoo►e�@ea st letltdvalt�tulagt�adi�'M a sC'e�'allaws aodthatnsigft Intl spamtapp)imb*a>wrisdist (Please check one) Owner Agent 1:3 • r Telephone No. PERMIT FEE$ DFPARTMVffOFPUBXS4FETY Permit No. BOARDOFFIREPREVk?MONRWMTIOAS5l7CKRI2.W �-d-.J,0 _ Occupancy&Fees Checked VAPPI:ICATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACI USSTS ELECTRICAL CODE,527 CMR 12:00 ;PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DateZ5,-- (!_ Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) "— Owner or TenantLm =La n Owner's Address 5A M 145 Is this permit in conjunction with a building permit: Yes r7TNo (Chect�A'Ppropriate Box) Purpose of Building /�Q�C '' � 1 tility.,Authorization No. Existing Service Amps` Volts Overhead Undergroundti �' N of Meters New Service Amps Volts Overhead r Underground No.of Meters —_ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /z// 1,4 1.PAID 77 ,5 lo No.of Lighting Outlets No.of Hot Tuba No,of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets _ No.of Gas Bumers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• 1 LuuaroeCara Pusuattothew ierrv0otAbmd=ftCkmmlLaws Iha%eaamertLiaWks araePbrym&&gCampl� Coat crilssuhstariialac}uvalet YES NO a k havestkmioedwWpaofof=nebtheOtliac YES Ifjtuhmedtad®dYES,pleagei k&ttetypeofa empbydWagt c bc` a MM E*rAmD* Est¢rletedV"d UmftWWdk$ i crklDSwrt Repmd Ragh FmW UrKkrTX LioerseNa F kale IizwNo Bus rmTd Nia AltTd.Na 1 SMURANCEWAIVER;Ianawaethattcrim se lheasrraloeameerils-gh amla rtaccaoWbylvlammbm sGerleilzm mys ant6'spearikgVimbnvAimttusregtomut se check one) Owner a Agent Telephone No. PERMIT FEE$ 3 6. 00 X4/2 to c j'Ze PU 4- �� 680.22 Article 680—Swimming Pools, Fountains, and Similar Installations (1) Consist of single receptacles receptacle is located not less than 5 ft from the inside (2) Employ a locking configuration of the Pool or fountain and is protected b =a�_GF P P Y CI, -; (3) Are of the grounding type As required by 680.22(A)(3),' each 'perinanep (4) Have GFCI protection stalled pool in a residential setting'is'required to (2) Other Receptacles, Location Other receptacles shall least one receptacle, which must.be located,at leas] be not less than 3.0 m (10 ft) from the inside walls of a from the pool and not more than 20 ft from the pool. of this requirement is to permit ordinary applianc pool. safely plugged in and used near the pool but to avoid ta1. i (3) Dwelling Unit(s) Where a permanently installed pool for extension cords in the vicinity of the pool.The 10.x' is installed at a dwelling unit(s),no fewer than one 125-volt mum dimension was chosen so that an appliance wi 15- or 20-ampere receptacle on a general-purpose branch cord could.not be accidentally knocked into the pool ' circuit shall be located not less than 3.0 in(10 ft)from,and Theprovision of 680.22(A)(5)covers receptael not more than 6.0 in (20 ft) from, the inside wall of the installation at dwelling units where the spatial'c pool. This receptacle shall be located not more t 2.0 �Znt locating the required receptacle 10 ft-or in (6 ft 6 in.) above the floor,platform,or grade le se the inside walls of the pool. Where this conditio the pool. one.-GFCI-protected'.receptacle is permitted to be Cl. than 10 ft but:not less than 5 ft.from theinsi (4) Restricted Space Where a pool i it n 3. (10 ft) o e pool. of a dwelling and th dime sion o to reclude meeting (GF�Vap�pplies tion of all '125 volt receptacles' the required clearanc s,n m one recepta e o e withi ool or fountain is'required by 6803 shall be permitted if of ss n 1.5 m (5 f s Ito' ools located outdoorsorIndoP horizontally from the ide w 11 of the pool. ( ", ly installed or storable,and for residential,or c}° (5) GFCI Protection 1115-and 20-am ere,sin le- hase, l/ use. Since people within 20 ft.of a .dol are no P g P P 125-volt receptacles located within 6.0 in(20 ft)of the inside jected to dampness and moisture, the GFCI,' walls of a pool shall be protected by a ground-fault circuit within the 20-ft space is warranted. interrupter. Receptacles that supply pool pump motors and Examples of receptacles'meeting de'regti that are rated 15 or 20 amperes, 125 volts through 250 volts, 680:22 (A)are shown in,Exhibits 680.'.. and,6, 4 single phase, shall be vrov I rotection. 680.5 illustrates that the determination of the nh --- — __ tante for receptacles from a'pool does not includ} All single-phase, 15-and 20-ampere, 125-volt through 25`- within a structure.,The receptacles Within the;'" volt receptacles that supply swimmnn g ool uric �moto� permuted„to,be less than4O ft from the pool ` / P PP Y g p P P are required to have.GFCI protection.While this requirement installation is at a dwelling unit,'it is nece applied only to installations at other than dwellings,in th8 1 at least one receptacle between i0 ft and I, inside walls of the pool. This-locatioal pre+r 1999 Code, the 2002 Code was revised to require GFCI protection of these receptacles for all:swimming pool instal- run the cord of an appliance used on'the lations.,It should'be.noted that 680.22(A)(5)applies to these , a doorway. .• 4QreceptacL_ePoegardles1s of their proximity 4o the swimming y pool and that it applies only to cord-and- lu =connected (g) Luminaires (Lighting Fixtures), Li pur"pmoto =► and Ceiling-Suspended (Paddle) Fahs (1) New Outdoor Installation Cle-ra-M s (6) Measurements In determining the dimensions in this areas, luminaires (lighting fixturesI),-:lig: section addressing receptacle spacings, the distance to be ceiling-suspended (paddle) fans installed aµ' measured shall be the shortest path the supply cord of an the area extending 1.5 in (5 ft)hodiontall appliance connected to the receptacle would follow without walls of the pool shall be installed at a h piercing a floor,wall,ceiling,doorway with hinged or sliding3.7 m (12 ft) above the maximum water I door,window opening,or other effective permanent barrier. (2) Indoor Clearances For installation The requireirients of 680.22(A) apply to recti areas, the clearances shall be the same : nea entl installed n. The do not unless modified as provided in this p Y ly to direct-connecte equipmen ermission is given in circuit supplying the equipment is,pro 6 0.2 e oc 'ng and grounding-type fault circuit interrupter, the following receptacle to supply a recirculation pump motor where the Permitted at a height not less than 2•a c_ the maximum pool water level: I 990 2005 National _ � �---� � .,,� r I �` r `- 1 � , I i { i a i y i 680.22 ARTICLE 680—SWIMMING POOLS,FOUNTAINS,AND SIMILAR INSTALLATIONS C(2) On or Within Buildings.Where installed on or within shall be located not less than 3.0 in(10 ft)from,and not more buildings, electrical metallic tubing shall be permitted. than 6.0 in (20 ft) from, the inside wall of the pool. This (3) Flexible Connections.Where necessary to employ flex- receptacle shall be located not more than 2.0 m (6'ft 6 in.) above the floor,platform, or grade level serving the pool. ible connections at or adjacent to the motor,liquidtight flexible metal or nonmetallic conduit with approved fittings shall be (4) Restricted Space.Where a pool is within 3.0 in (10 ft) permitted. of a dwelling and the dimensions of the lot preclude meet- (4) One-Family Dwellings. In the interior of one-family Ing the required clearances, not more than one receptacle dwellings, or in the interior of accessory buildings' a`ssoci- outlet shall be permitted if not less than 1.5 m (5 ft) mea- ated with a one-family dwelling, any of the wiring methods sured horizontally from the inside wall of the pool. recognized in Chapter 3 of this Code that comply with the (5) GFCI Protection. All 15- and 20-ampere, single-phase, provisions of this paragraph shall be permitted. Where run 125-volt receptacles located within 6.0 in (20 ft)of the inside in a cable assembly, the equipment grounding conductor walls of a pool shall be protected by a ground-fault circuit shall be permitted to be uninsulated,but it shall be enclosed interrupter.Recce that supply pool pump motors and that within the outer sheath,of the cable assembly. are rated 15 or 20 amperes, 125 volts through 250 volts,single (5) Cord-and-Plug Connections. Pool-associated motors phase, shall be provided with GFCI protection. �UM P I-1k411v shall be permitted to employ cord-and-plug connections. (6) Measurements. In determining the dimensions in this The flexible cord shall not exceed 900 mm(3 ft)in length. section addressing receptacle spacings,the distance to be mea- The flexible cord shall include an equipment grounding sured shall be the shortest path the supply cord of an appliance conductor sized in accordance with 250.122 and shall ter- connected to the receptacle would follow without piercing a minate in a grounding-type attachment plug. floor,wall,ceiling,doorway with hinged or sliding door,win- dow opening,or other effective permanent barrier. (B) Double Insulated Pool Pumps.A listed cord-and-plug- connected pool pump incorporating an approved system of (B) Luminaires (Lighting Fixtures), Lighting Outlets, double insulation that provides a means for grounding only the and Ceiling-Suspended (Paddle)Fans. internal and nonaccessible, non-current carrying metal parts of the pump shall be connected to any wiring method recog- (1) New, nized in Chapter 3 that is suitable for the location.Where the pool areaIn outdoor Outdoor Installation Clearances. d s, luminaires (lighting fixtures), lighting outlets, and bonding grid is connected to the equipment grounding con- ceiling-suspended(paddle)fans installed above the pool or the ductor of the motor circuit in accordance with the second area extending 1.5 m(5 ft)horizontally from the inside walls paragraph of 680.26(B)(4), the branch circuit wiring shall yea pool shall be installed at a height not less than 3.7 m (12 ft) above the maximum water level of the pool. comply with 680.21(A) 680.22 Area Lighting, Receptacles, and Equipment. (2) Indoor Clearances. For installations in indoor pool areas, the clearances shall be the same as for outdoor areas (A) Receptacles. unless modified_as provided in this paragraph.If the branch circuit supplying the equipment is protected by a ground- (1) Circulation and Sanitation System,Location.Recep= fault circuit interrupter, the following equipment shall be tacles that provide power for water-pump motors or for permitted at a height not less than 2.3 m (7 ft 6 in.) above other loads directly related to the circulation and sanitation the maximum pool water level: / system shall be located at least 3.0 in(10 ft)from the inside (1) Totally enclosed luminaires (fixtures) l walls of the pool, or not less than 1.5 m (5 ft) from the inside walls of the pool if they meet all of the following (2) Ceiling-suspended(paddle)fans identified for use beneath conditions: ceiling structures such as provided on porches or patios (1) Consist of single receptacles (3) Existing Installations.Existing luminaires (lighting fix- (2) Employ a locking configuration tures) and lighting outlets located less than 1.5 in (5 ft)mea- (3) Are of the grounding type sured horizontally from the inside walls of a pool shall be not (4) Have GFCI protection less than 1.5 in(5 ft)above the surface of the maximum water level, shall be rigidly attached to the existing structure, and (2) Other Receptacles, Location. Other receptacles shall shall be protected by a ground-fault circuit interrupter. be not less than 3.0 in (10 ft)from the inside walls of a pool. (4) GFCI Protection in Adjacent Areas. Luminaires O (3) Dwelling Unit(s).Where a permanently installed pool is (lighting fixtures), lighting outlets, and ceiling-suspended installed at a dwelling unit(s),no fewer than one 125-volt 15- (paddle)fans installed in the area extending between 1.5 In or 20-ampere receptacle on a general-purpose branch circuit (5 ft)and 3.0 In(10 ft)horizontally from the inside walls of 70-532 NATIONAL ELECTRICAL CODE 2005 Edition Location BAWhAr-qJ �(1. No. �?�o Date NORTH r TOWN OF NORTH ANDOVER I•Ah k41 Certificate of Occupancy $ Building/Frame Permit Fee $ I Foundation Permit Fee $ E ' sA MUSE Other Permit Fe $ "= Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 2 Building Inspector � 11:20 25.00 PAID s= 9 3 1 3 Div. Public Works PERMIT NO. a ._ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. VAr I MAP 4J0. LOT NO f� _ 2 RECORD OF OWNERSHIP DATE BOOKy— PAGE � {; oI !!k : ZONE I SUB DIV. LOT NO. 1 i -3` �, ! COCATION1112 �l&,.6CLr- /l/(J r✓/CfOYI�/!! � POSE OF BUILDING ✓OWNER'S NAME NO. OF STORIES U(it SIZE iL �` } FX OWNER'S ADDRESS BASEMENT OR SLAB _ t +'Y• ARCHITECT'S NAME L J SIZE OF FLOOR TIMBERS IST 2ND 3R_D f� li f I„ qtyp;Pl�r.. , 413 �BUILDER '8 NAME ZZ / SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS fg ' POSTS DISTANCE FROM STREET I r �irfi I sr„ y� GIRDERS DISTANt�E FROM LOT LINES —SIDES REAR � gg} , 9 AEA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS o � 1 q yy IS BUILDINd-NEW SIZE OF FOOTING % Fqr j' ,Pxp�t�F ATERSAL OF CHIMNEYrIS BUILDING ADDITION jf pq - IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND y WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER 2K y S ro tskasU�n�4 BOARD OF APPEALS ACTION. IF ANY 13 BUILDING CONNECTED TO TOWN SEWER I C 1 yl�tr P 1 L Tty ��_ IS BUILDING CONNECTED TO NATURAL GAS LINE .j,I 'Iyz I Irt �” j)) ffiP6 PROPERTY INFORMATION z t x INSTRUCTIONS i s g I i 11 LAND COST FItv ai fi SEE BOTH BIDES / T. BLDG. COST 6 co co EBT. BLDG. COST PER 80. FT. +" PAGE 1 FILL OUT SECTIONS 1 • 3 I EST. BLDG. COST PER ROOM i ' I x g ' PAGE 2 FILL OUT SECTIONS 1 - 12 I . w T SEPTIC PERMIT NO. I � 4RA ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY " *4 x 1 ,• + �•� �`w'� � ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS i "I PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR k i *kl t DATE F D 7. q7I T . } AGENT BUILDING,INSPECTOR II#1 r,tw,; ° .. m�, ✓ 4 Oi �i�..� Jv SIGNATURE OF OWNER OR AUTHORIZED I 1 j r {, +d 4�14"A �` OWNER TEL.k F r . 4= E E x r y ► zl PERMIT GRANTED CONTR.TEL.# r , 19 CONTR.LIC.q ; I fiR M.I.C.M ! �! s xy{� "V gg t'A7 i t WOOD ST10_VE INSTALL4HON CHECKLIST-77 .y -- ,rcr�^ws.f:.r .gt.4..+r..u.Y•x• s' n ... ""r+`����"_w:n.-t a - �r _ rs,K.2. + ' Permit . "q- .� :_ '. ,.:. ; .:a. �.�;��-_:::_.•_ _ ;_:�:._. � �,..,.: .�:� .:. ._,.. A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and-not to the stove construction. Stove :_ A. New ✓ Used B. Type/radiant Circulating ` C. Manufacturer Lab.No. , Name/Model No. Cnflarsil ' Dimensions/Height , l8" length ar S" Width Chimney A. New Existing B. Size(flue area) " X " ' C. Other appliances attached to flue(Number and flue size) . Akne' 0. Prefab(Manufacturer—name and type) AID E. Masonry/Lined UhPd Flue liner Unlined •iyae&rnanutacturerl F Height(refer to diagrams) cap�P C GVEl Z IC ,,3`MIH. ..�. .� Ir]. -"'�•ilft. NtA. �:, HEARTH 1 X, CHIMNEY HEIGHT Hearth(non-comb stible A. Materials � B. Sub-floorconstruction C. Minimum dimensions(refer to aiacrami C'earances and Wail Frotecitcn(see slc-e'.f'Stailat:cn C!ea!ra nc-s chart) . A. Type of wall protection provided 'r B. C+earances(refer to diagrams) I� I FIREPLACE CORtIER WALL'CENTER. 13 4 i } Location / . No � � Date / . \ . j0*T. , TOWN OF NORTH ANDOVER \ 00 \ 0 \ 4i ) . %& Certificate of Occupancy $ / 7 's��s� BmmmgFmmePrm|! Fe $ \ ` Foundation Prmi! Fee $ ) Other Permit Fee $ / TOTAL \ Check # � ) \ ] 2272 . (/�--Budm @ped/ } • a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ri Of icia BU LDING PERNUT NUMBER: b � DATE ISSUED: G X SIGNATURE: ,/�✓l ��� Buildin Commissioner/I for of BuildingsDate SECTION 1-SITE INFORMATION 1.1 Property,Address: 1.2 Assessors Map and Parcel Number: o l-°l &Wnm ,J nve Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (j , Zoning District Proposed Use Lot Area(so Frontage(fl) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provi d Re red Provided 1.7 Water Supply M.G.L.C.40. 34) I.S. Flood Zone Inforuution: 1.8 Sewerage Disposal System: Public ❑ Private ❑ TA°C Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of' Record Name(Print) Address for Service fir- 617. Sq 2, os$6 t Signfzturc) Telephone Gett 978. 3�y, 667 2.2 Owi;er of Record: Name Print Address for Service: O z i�namre _ Telephone,. m iECTION 3 CONSTRUCTION SERVICES t.l Licensed Construction Supervisor: Not Applicable 0 .icensed ConstructionSupervisor: Q 10��fl O SOLicense Number Aaturee��, /�/WU�'' ' ��l� 06 'Expiration Date Telephone r- 2 Registered Home Improvement Contractor Not Applicable 0 0 )mpany Name Reg at Number r Idres U I 02-- 1,1707 Expiration Date ;nat 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....:X_ No.......0 SECTION 5 Description of Proposed Work check all a licabte New Construction �^ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑. Accessory Bldg. '❑\ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: l�'INh SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be— Completed eCom leted by permit applicant 1. Building (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingBuilding Perrnit.tee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a-OWNER AUTHORIZATION T6 BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> 04• 1 el 15 as Owner/Authorized Agent of subject property Hereby authorize to act on My bewt" ill nrsrs r� work authorized by this building permit application Si nature of Owner Date T— SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, ` l- as Owner/Authorized Agent of subject property Hereby declare that the statea and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Na 1 Si azure of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1 ST2ND3 SPAN DIMENSIONS OF SILLS D12vIENSIONS OF POSTS DMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIYMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE R � is's e' pw H a• a K s' r-7 to/ttr C Y # s' D Ir-S 3/t a / SUARD Nor wcluDO 2Y-i 7 Z 4' wr-e' 4• 8' D-B - tr-i 13/.1 C D H - 1 T-7 1519' N-� D-K - 1T-5 13/14r 6• 8' 1 I C-E - 9'-1 711 16• C - 18-1 'S/ta• WATER FULL SPA MON Z-A + 9'-10 SAC MAX.tVMH tOP TP OF Z—G - 9'-4 311d' Via' DWW 9OMRD P E--K - IV-0 311C 4' 40'YAIt. ---------- -- Do. �r 94'd PE7101Ei£R 23280 OAL , 571 SO.FF. •sem bATOrt t t/•t sorrow 10-0 314— SgAFACE 35'--e 3/4 UWAUARON TO BE IN ACCORDANCE FOX POOL. CORP. RECOWAEDAWK 1. X--SPAM ON 4-d SPACM FOXXX POOL COM 2, SAFETY LP E 11r RIM ewm 3. • n+PMAW-UNUM D" t*MM D+°BOMD 2238 LAGOON RIGH' TYPE it 4. Q- CRtitER UNE c0 ALL RlONlS RESEINED SC" 02-597C z M The Commonwealth of Massachusetts r d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 °�M 5ye Workers'Compensation Insurance Affidavit Name Please Print Name: Jam, iU lack 11IJ Location: r! Ci w AJ Phone # 9 W- jE I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity ENI am an employer providing workers'compensation for my employees working on this job. Company name: (� Address 10 dU City: 1 r v f Phone Insurance.Co. 2�TJT Poligy Company name: , Address Com: Phone#- Insurance Co. Policv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,5oo.00 and/or one years'imprisonment.as weU_as_civil,penatties'jnlbelnun-cf,a_ST_OP WORK ORDER and_a.fine_of($IJEIO fJ)-asiay against-me. l understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify der the pains and penalties of pegury that the information provided above is true and correct. Signature (-A kDate � f. QST Print name ::z7wa �Jj).XAi Phone.# Official use only I-J-T d6f7d write in this area to be completed by city or town official' City or Town Permit/Licensi � Check if immediate response is required Building Dept [ Licensing Board p Selectman's Office Contact person: Phone#: E] Health Department Ei Other FORM - U - LOT RELEASE FORM. INSTRUCTIONS: .This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction p g have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements, APPLICAN TS ��0�1��'luj PHONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET _ j STREET NUMBER IMMUNI OFFICIAL.USE ONLY 1.11111..r............r...■■.r.■■.■■.....■■.■■■■........................r....■ RECOMMENDATIONS OF TO AGENTS ■....e ■.rr...rr.r....r.■ 1111 ■■..■■..■■....■■■...........r...rrr..r.r.rrrr.■ DATE APPROVED COVERVATIONADMDUSTRaAT R DATE REJECTED COM14ENTS To 06cj ocLf6rCY2, of too 2os1 DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED WFOODECTOR-HEAL DATE REJECTED DATEAPPROVED .� Z�+ 8PECTOR- TH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER QNNECAf DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE p r a �i. � '" t � � � ... .....�, .., f.' ACORD CERTIFICATE OF LIABILITY INSURANCE OPID P DATE(MbIlDD/YY11� FAMILO3 01/05/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB International New England HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 299 Ballardvale St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington MA 01887 Phone: 978-657-5100 Fax:978-988-0038 INSURERS AFFORDING COVERAGE NAICtE INSURED INSURER.A, Scottsdale Insurance Co an INSURER B A.I.G Family Pools & Patio Inc. INSURER 70 S. Broadwayy INSURER J: Lawrence MA 01843 INSURER= COVERAGES TFE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T-iE 1NSUP•EC NAMED ABOVE=OR THE POLICY PERIOD!NDICATED KCTWITHSTPNDING ANY REQUIREMENT.T=RM GF CONDTION OF A'4Y CONTRACT OR OTHER DOCUMENT YVITH RESPECT TC YWICH-HIS CERTIFICATE MAY BE ISSUED OP, MAY PERTAIN,THE INSURANCE AFFORCED BY THE PCLIC ES DESCRIBED-1EREIN IS SUBJECT-0 ALL-HE-EPMS,EXC_USI*DV3,AND CONDITI�'V:S CF SUCF- POLICIES AGGREGATE LIMITS 51", 'N MAY HAVE EJzEV FECUCE7 BY PAID CLAJMS. LTR NS TYPE OF INSURANCE POLICY NUMBER DATE(MWDDIYYJ OATS TXPR T LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIAL LAIMSMGENERAL_WOCCUBILITY I THD 12/31/04 12/31/05 PREIA53'S Ea_Ureoce) s 100000 CLAIMS MADE OCCUR MELD EnP(Any cn=parson) S excl I X $2500 dOd PERSCNk&ADVII•JJURY 51000000 - GEN'LAGGREGATE LIMIT APP_IESPER: GENERA_AC,3REGATE s2000000 62000000 POLICY PRO- JECT L' Emp Ben. 1000DOO AUTOMOBILE LIABILITY COMBIVED SINGLE LIMIT ANY AU-0 (Ea aocidan:) S ALL ONVIED AUTOS SCHEDULED ALTOS BODIL''INJURY S f.Par pKsonl HIRHD AUTOS NON-OWNED AUTOS BOD:L"IN,U<4' S (Per accidant:i PPOPERTi CANIAGE S (Par axidantl GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ AfJY AJUO 0T1-ER THMI EA ACC S AUTO ONL Y: AGG S EXCESSIUMBRELLA LIABILITY EACH C;O=L'RPEPICE S OCCUR CLAIMS MADE AGGP,EGPT= ti S DEDUCTIBLE S RETENT ON g S WORKERS COMPENSATION AND : Eh1PL0YERS'LIABILITY X TCRY LIMITS ER B ANY FROPRIETURIPPJTfNERIE•.XECU-I'VE- WC6926440 12/31/04 ' 12/31/05 E.:_EACf-ACCIDENT $100000 OF=ICER/MEMBER EXCLLCED? If ves,describe under E.L.DISEASE-EA E'AP-OTEE.$100000 SP_OPL PFCVISIONS boim E.L.DISEASE-POLIC-!LIPoMIT S 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIA.L PROVISIONS CERTIFICATE HOLDER CANCELLATION BT.A —O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED R PRESENTATIVE ACORD 25(2001108) CORD CORPORATION 1999 Ud U1 : 44p i=smil 9 Pools @� Patios Inc 9706691949 P- 1 •; '. v R�ti`J0776PlLpnC/M�y��/i.�•ft40CipNtideoep ' 15DARD OF BUILDING Rr=g0L.AT10NS License; CONSTRUCTION SUPERVISOR Number; CS 010330 alrthdOW'07/19/1960 E*.Irds:07/19/2005 Tr no; g1 Restrloted: 0o WILLIAM C PI3ULOS 70 S BROADWAY LAWRENCe, MA.01843 Admin �strator Board of Build'in Re One Ashburton place, M 130 IIS l.lcensg: CONSTRUCTION SUpERVIS808ton, Ma 0210$-1618 301 - Number; CS OR LICENSE 010330 Expires:07/1 g/2005 Birthdate: 07/19/1960 Restricted To: 00 WILLIAM C POULOs 70 S BROADWAY LAWRENCE, MA 01843 7 Tr,no: 61 Keep top for recelPt and change or address n odfication. j F' r 3, "r Boa7,r f Building Reg Z�ns and Standards d 50 ,w a.: r 8One Ashburton Pl ce - Room 1301 Boston. Massacusetts 02108 Home ImprovementC ` tractor Registration y. Registration: 11-8204 I g - - Type: Supplement Card zl . - _.. Expiration: 2/13/2007 FAMILY tLY l POOLS.& PATIOS INC GLEN WIGGING � � w 70 S:�dBROADWAYfi::- p ` P� z LAWRENCEMA"01843 Update Address and return card.Mark reason for change. DPS-CAi ip 50M-04/04-G101216� ' Address Renewal Employment, E] Lost Card, --- — — --- ¢�le�omvnzo�zureald a�✓�4zaaae�ivaeka -------- - - �. Board of Building Regulations and Standards L�-erase or r ' e istration valid f g or mdividul use only tHOME.IMPq OVEMENT;CONTRACTOR b fore the expiration date. If found return to: ` �¢Registratioj i8204 �n. .' Burd of Building Regulations and Standards t ; 3/2007,;-." r ^ Oe Ashburton Place Rm 1301 ra ion— u lse u ement Card. B Ston,Ma.02108 1,• FAMILY POLS. 1 3l�SIN ° GLEN WIGGING' 70 S.BROADWAY LAWRENCE,MA 01843 Administrator Not valid without si na r z f k •'le , FE. as .. ;: tl i c t d i 4 .{ t k 1. 5 F k . . f ..,... ,�` 4, ... ;�- ' . _.. z: ._,_.. '� r NORTFI ovm- of 4 over T C, LAKE y dower, Mass.,12L- � • i •Q Sc' COCHICHE WICK �d AORA7 PPS\ �C2 `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT...........I1i1....... 5 ......Iii BUILDING INSPECTOR ........ so ... Foundation has permission to erect..�. ........ buildings on ......Vf ........... /t �A NNO ti - Rough ................................................... to be occupied as10.06 IO � N �� � ...... �. Chimney p1............................................... . 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. 438/x/3 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough k PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO STARTS ELECTRICAL INSPECTOR Rough . Service........... .. ..... .0 . .. . .............. ....................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place. on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumec Street No. SEE REVERSE SIDE Smoke Det.