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Miscellaneous - 61 COACHMANS LANE 4/30/2018 (3)
61 COACHMAN'S LANE 210/037.A-0023-0000.0 Date.. ...... ...Aa... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................ ............./................................. .............. has permission to.perform ........ ..........................................f.......... .... wiring in the ilding of..........,,4- ...................................... P................................................. at North Andover,Mass. ........... .............................................................................. Fee.l�.................Lic.No. . ................... ELECTRICAL INSPECTOR M 77 Check# 131 27�-' - � Commonwealth of Massachusetts Official Use Only ' Permit No. 1512--7-1 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT IYAW OR TYPE ALL MFORMATIOA9 Date: L City or Town of: NORTH ANDOVER To the Inspector Of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) f,2 ( G0�4-testi`5 LA Owner or Tenant ('-)A <, PAP4-t t/.� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building fef�-(-#')C'As/1 A-1— Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Locat' n a d Nature of Proposed Electrical Work: Completion of the following table maybe waived by the Inspector of Wires. of No.of Recessed Luminaires No.of Cell: TransSusp.(Paddle)Fans Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency rg fing rnd. rnd. Batter Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices o Total No.of Alerting Devices No.of Ranges N0. f Air Cond. Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: ......................... Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No.of Devices or E u valent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o Elec ical Work: O� (When required by municipal policy.) ed' accordance with MEC Rule 10 and upon completion. Work to Start: Z-1, I Inspections to be request m a r w p p INSURANCE C GE: 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 cover is m force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Icertify, under the ains andpenalties of perjury,that the information on this application is true and complete. FIRM NAME: . 0 LIC.NO.: L ' Licensee: , Signature V,,A LIC.NO.: Z7 ft) (If applicable enter "exempt"in the license number line) Bus.Tel.No.: Address: P.O . Alt,Tel.No.: !�2 R-�)7 ,6 *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 Fppj�WT7 FEE: $ cl — Signature — Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the 4 permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, §32,an t` electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSP TION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: 42 Inspectors Signature: Date: r; FINAL INSP TION: ` Pass F?1 V Failed 0 Re-Inspection Required($.) ❑ r Inspectors Comments: Inspectors Signature: ate: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 � www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERAUTTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organization/hdividual): -t-t Address: 0,Q /J 0 >: t abZ_— City/State/Zip: y cc c_4 .telet- 0t9"3SPhone#: Are you an employer?Check the appropriate box: Type of project(required): 1. a employer with _employees(full and/or part-time).* 7. ❑New Construction .2.[J I am a sole proprietor or partnership and have no employees working for me in 8. emodcling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t ❑4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11•.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.EJ Roof repairs These sub-contractors have employees and have workers'comp.instuance.$ 6.F1We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Other 152,§1(4),and we have no.employees.[No workers'comp,insurance required.] *Any applicant that checks box#1 mast also fill out the section below showing their workers'compensation policy information. t Homeowners who subnnf 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 mustattached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors fiave employees,they must provide their workers'comp.policy number. Iain an employer that is piovidiiig workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: •4 Policy#or Self-ins,Lie.#: Expiration Date: Job Site Address: (o ( CO&CG-f At A ,J S City/State/Zip: J fA to Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA,for insurance coverage verification. Ido hereby certif under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: -7 ZZ l 6 Phone# 7 �l" 37 S^'O Lf6 Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. n �, Pursuant to this statute,an employee is defined as"...every person in the service of another under any contrac't'of lure, express or implied,oral or written." ' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Date..... r . ." gORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING 88�cMug� v --7f1l"C This certifies that .....................:. ...�".....� ;tL................................................... has permission to perform .............. / �� I u��(� � ......................................................................... wiring in the building of............... ./...74t................................................................... at ....&.1...Cbal/fj.!t.................. .......... ...,North Andover,Mass. d.� �i QQ .Fee.'.� ....."1�..LIc.No. .. ..`. �� /I... ELECTRICAL INSPECT Check# 3 7 11585 cnwouse only BOARD OF FIRE PREMMON REGiRA77t NS La qffiwywdSwCb=W APPL CATI ADwoki?N paERM�-TO PERFORM ELECTRICAL WORK Atl sktubc ffi �e t (�,V7 Cha 128ti {PLUSUPRtN3 RIAW OR TJ'PBAURPORMAnoffl (dig 8r Togs eft 1VU1 � `o t this givesnnt�ee of6is exbrr' �eaor I.aratiou(Street�c Namttcr3 ;° dbe ebucWcd WO&d0mibcd bdow_ ntit,�S /AJ OwnerorTeaaat G�l,�?�--� Ihirner�sAddress — TaephoaeNo. Ls�Permif is wig a per= Yes Q - Pucpme of Bu1�g No (heck Appropriate Box) service Ute►Authert sdmNo. Reafwg Amps —v°ft Ovwhmd Q Undgrd Q Na.ofAdeters New Service -Amgs t ' Overhead Q Undgrd❑ � Ra.of it+leters Number of Feeders and Ampaerty Location asci Nature of Fropaaed Bleetrieet Work: /C�/12�[r�G" No,ofRocessed futile be trirrd the re ft-= ofe}i?aw - .of T No ofLonliffake p - PYA o.ofHuETubsGtommtors KVA No.of Lundmahvs - Pool Q No.ofRecep cle,ounds i efoa s AI iBiLiS �� No.efS�rs -aft�ss � na No.of l C ofAkOm Tom � f No,of Wasie _ Totem _ No.ofD as - Na,of Dryers H a.o Wafer �fW - �euftAppftnm - �' lYa:d $r t Healers BadWflf N%oofDevi=ori N&�Bafhtnbs Na.of IMotors TOM HP OTHER: WafDedmor t Fstmrsaled Yaha:of cal Warms �d��'[rst8q�db�+lhe l�orof FPttEs WoalimS`� ho�bbEin=qtmWbYIxdic3=} HWORAil M covMAIM wig Ruk 1( and ugan oo¢agbsian. ' �� ��astfar#be cf vpork maq issue ueiess ropes crib MktUW egdmdm- Ilse CFIECg ONLY- I1hT�f jRAN BOM m i�ami b$s� ' ofsam ft&cpcW&issuing �� Df ,tfrstt&eiofosorttkis eurdeaa�t� iBM NAMf i:L s i.T2�C� G�uT �c 1'it3trai [If�p!rarb�e�c -iaAaeers�6er�ej --"— NO if tb� Address: AAMU#-,` `Yt� t!I#�'7 8MTeT.Me--97r-'i$:2 &2- *Per?&G.I_m I47,s 5UI,se wa& afpdAIG 7'd.Noa - 571 0WIRRIS B MME WAMM- I a}n aw a tbai the ' Lim Na tlaesim�lamethe ' BYmYY i ambr.Fely,Ihere6gwaivett ie2wwdAgmtq Iffit�e�i Q Qovmes 7t SipaturiTeIeplcoseNa �' 'F.�E:$ -' 77te COmmOnwwealth Of MaaacknwYs Print Form m4 Offiw -- ofa 1 CongressSW4 suiteIN BOs1014 DIA 0211¢2017 wwty rnMgov/ufia Workers'Compensation Insurance Affidavit:Bm7ders/Contractors/Eiectriciamirifimbers UIicaat Information _ Please Print LeI ibly Name Bus neW0 ganh260n/indMdW). DAVID ELECTRICAL CONTRACTING LLC Address_ 87 BEL.MONT ST Cityr.gabMjL- - NORTH ANDOVER,MA-01845 Phone#: 978-682-6262 Are you an employee Check the approprbtebo= Type of pmJed(required): I_O I am a cmplOyerwiffi 7 4- ❑I am anal contractor and I maplayees(frill andtcwpa e)* have hued the sub-contractors 6. ❑New construction 2IIIamasole,propdctororpartner lismdonthe 7 []Remodeling ship and have no employees These have 8- ❑Demolition woddog forme in airy c4aci€y employees and have workeW [NOwOrlo&comp. a comp.Wince.'' 9 Q Btu3dmgadditic n req° -1 5.❑ We me acorporation and its 10.0 Electrical repairs oradcblions 3_II lam a homeowner doingall work officashaveexermsedd= I I-[]Plumbing repairs or additions myself NO wod ess'comp fi&of can per MGL rem.]s c 152,§1(4),and we have no 12 Q Roof repass employees-[NO workers' 13-Q Other comp.insamnoe required] 'AWapplic W that d=ks box-#1 mustaLso fit out&c section Wowdmwmg thewwow Pow,icor t Ha-.=vnets who submit Ibis affidavit inaicawng they ate doing all wo*and then hire outside contuse must submita mew affidavit iadiratim sari +Conus thatched:tbaboxmustatiachcd an additiond sheet sbowiagfficu ueof the its and shifewhethwor tart&sc have emPbyeesv Uthe sabtvntracOors have emptoyeesy flay must provide their svod=e eomg,porky wmba 1 t7►saf is p+�ovidmg ivorke�s'comper�c�rvn irtsam¢rrr� or Betmv is ihepnfcy mrdn►hsrte Insurance Company Name.. THE HARTFORD Policy#or Self-ins.Lia#: 48 WEC C18293 Expiration Date. MARCH 1,201TL Job Site Address: 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 tri S1,500-00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of uP to X250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lnvestigations of the DIA forpinpuranceyoverage verification Idoherebycaffy of Pkat " - - -propMed above is&m and conjxL ED Phone Offid d ase only. llo safwy&jg&&area,f0 be Eby cry ar fovea ofcfa City or Town: Permit&icense# AUMOR iity(circle ones L Bowd of Health 2.Building3 Cityf f'own Clerk 4_Electr�I Inspector 5.rhrmbing Inspector C NflactPets� Phone#: Date.. . .. Z/ .... .. . .. . .. . . TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that", k".. . . . .✓. . . . . . . . has permission for gas installation z./, ;r. . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . xs at orth, Andover, Mass. Fee36 . . . . . Lic. No/2 -i. . . . . . . . . . . . .. . . . . . . . . . . . . . . . 0ASINSPEGIOR Check# Jy 4663 MASSACHUSEUIS I.IN MRM APPUC TO #FOR PER Wr TO DO GAS FfrnNG (Type or print) Date 7 �� NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# T=G Amount$ Owner's Name S-,(4p Qi4&iyek New 0 Renovation d Replacement ❑ Plans Submitted. Ua4 (n W a O OU p Ems+ x z O W Q p D p W FW. CC w z N a o a xW x x w . g H x z WF-4W a a 0 o a o z � x O w A a UO a A ate. H O SUB -BA SEM ENT BASEM ENT 1ST. FLOOR 2 ND .. FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR LL ( Pf 79 Print or type) Check one: Certificate Installing Company Name IEL E d44-1' ❑ Corp. Address ❑ Partner. Q,mm /N 0302P Business Telephone (03-$f,3- 4 S'f� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: Yes No I have a current liability Insurance polic r it's substantial equivalent. ❑ ❑ If you have checked yes,please in ' ate the type coverage by checking the appropriate box. Liability insurance policy IET Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: i Signature of Owner or Owner's Agent Owner ❑ Agent ❑ ' I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the �( best of my knowledge and that all plumbing work and nista i ns performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach etts tate s C and Chapter 142 th I Laws. nature of Licensed Plumber Or Gas Fitter Plum Tit Title Plumber City/Town ® Ga itter Icense Number crqaster APPROVED(OFFICE USE ONLY) ❑ Joumeyman Date. . :3 -` .: .�. . . + TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING ''tSACNUS� This certifies that . . ... . . . . . . . . . . : . . . . 'has permission to perform . . _ ^ !. . . . . . . . . . . . . . ,plumbing in the buildings of . . u :-of . . . . . . . . f at. . �. . . ..�. . . ... . ..``. . . . . . . . . .U North-Andover, Mass. Fee!. . �. . .Lic. No.���3�.d. . . . . / c>a. h, . . . . . . . . . . PLUMGNSPECTOR Check # 327 (: 529 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN( (Type or print) NORTH ANDOVER,MASSACHUSETTS / / 0 Date •/ / Building Location C®/ w ersame S -&z Permit# Amount T e of c u anc New ❑ Renovation ❑ Replace en t Plans Submitted Yes No FIXTURES E~ w w as 1C) � a A SM-Em R4SE" Ti' / ze HIM 3MHD 4M . 51H KJ0C R 6UMM 81H MOOR (Print or type) Check one: Certificate ' Installing Company Name ❑ Corp. Add ess ❑ Partner. Business one O Firm/Co. Name of Licensed Plumber: 420-vjg�' Insurance Coverage: Indicate the t nsurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above I threeinsurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have su tted or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and in atio performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa u tate mb' Cod d C of the General Laws. By: Signature of Licenseuriumoer Type of Plumbing License Title City/Town License Numner Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date... . {� ...U. Y- T10RTM Ottt�ao .,,ti0 : .�„ o O- TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACMUS� This certifies that ..... ................................. .L..i' T/1<<.a..l............... has permission to perform !� ���'�1 wiring in the building of.......... ..<'.......�Cc � ........... ........................... t C.(.... .6 v�a 14 S L North Andover,Maes- Fee ae Fee...F�.s .vv. Lic.No.l.�/. jf............ .!!L:.... . ELECTRICAL INSPECTOR Check # 4986 Permit u ss�G�us��s P�)),� Dyrxurt ad P Occupancy&dee Chec BOARD OF FIRE PREVENTION EG: IONS 527 CMR 1 2:00 APPLICATION FOR t'rdaite M T TO PERFORM ELECTRICAL WORK All work to be performed in a with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Dater'_I ZtfoA To the Inspector of Wires: Town of North Andover The undersigned applies for a//permit to perform the electrical work describedbelow. Location(Street&Number a ( CO_ACa.Mq .J ` 5 L_" l ` Owner or Tenant ��S L) +G PA P A-L_t h Owner's Address l�klyke Is this permit in conjunction with a building permit Yes No U (Check Appropriate Box) Purpose of Building�W ` Qt k'�A-Il,� Utility Authorization No. Existing Service Amps Vods Overhead 0 Undgmd u No.of Mete New Service Amps Voits Overhead 0 Undgmd U No.of Mete Number of Feeders and Ampacity aL,,,t ki OLL Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices _ Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers Spa ce/Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of. No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds I No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includ pleted Operations Coverage or its substantial equivalent/&;j:110 have valid proof of same to the Olfic YES'- NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. /�INSUFt} BOHERtease Specify) J-� (Expiration Date) Irn VLVtPe�na�lbe's 1 Worka d Work to StarInspection Date Resquested Z� 0 Rough Final Signed unde of perjury: FIRM NAME LyG%r °` �✓ L1.5 LIC.NOA k_Tt Licensee 1' moi V A-t 8,C14)y r✓ Signature 2 L� LIC.NO. &7'60 Bus.Tel No. bb 3 �-t Z- J 6'8-I Address �✓" � — Oa � AAA AltTel.No. -) S7 -o Z_ OWNER'S INSU CE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Mass; General Laws.An that my signature on this permit application waives this requirement. Owner Agent (Please Check one) �! 5/ Telephone No. PERMIT FEE 99 (Signature of Owner or Agent) The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigatians a� Boston, Mass. 029 9 9 9 Workers'Compensation.Insurance Affidavit Name Please Print Name: Location: City Phone # I 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 jot Company name: Address Cite PFS# Insurance Co. Poliev# i Company name: address.. P Insur_n.m.Co. Policy-# Fa kwe to secure coverage as regwred under Section 25A or Met 152 cMlegxf to#M kF po&*on a c6mw"Pees of a Tt and/or one yews'Wnprisorxrxmt-as-weU is-cW Rena yu36eSmm��fa SJQP finesif( II1Qt1 � understand that a copy of this statement may be forwa►ded to the Office of hnvestigabons of the DA-for coverage ver mon. s - i t db hwebycefi*wxler the peens and panaMre-s of perjwy dart the inho mafim povri*d abot a is trine and correct r Signature Date Print name PhOae- Ofiiciat use only do not write in this area to be completed by city or town officiar City or Town ung E3tt ❑Check it immediate response is.reyured [ ba ❑ Sel' Contact person: Phone#: ❑ Hei E! 0# .� ���� Office Use Only v� ai 4t TII IUP 111 5a11�1L'il Permit No. �L a aq==Cd of Pubur Safetv O=upan y A Fee area r BOARD OF FIRS PREVENTION Rcu"UUTIONS 521 CMR 7200 3= Deanne oianiq APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1200 (PL�4SE PRINT IN INK OR!.�P ALL FO MATION) Date S - 1' f s City or Town of Nd4t� � To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 1 Cy'4' '""`'4`^-S A.VX - Owner or Tenant A►� >J✓1 a lis: �. ��'� C�/►�-5?. Owner's Address is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building - Ut{iity Authorization No. Existing Service Amps _J volts Overhead ❑ Undgrnd ❑ No. of Meters New Service __Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Mete. Number of feeders and Ampacity Location and Nature of Proposed Electrical Work _- k u.aP id y IoM.i n-y4 C 7 - No. of Transformers Total No. of Lig ting Outlets I No. of Ho:Tums I KVA Abover In. No. of Lignting Fixtures, I Swimming Pool crud. gmd. ❑ Generators KVA No. c =meroency Ltgntmg No. c: Rece.-tacie Outlets + No. of C:: Burners I flattery Units No. of Switch Outlets I No. of Gas Burners I FIRE ALARbtS No. of Cones es No. of Air Cond. Total No. of Detection and No. of Ranges" I tons Initiating Devices No. of Dir:osais ( No.oi Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Comi-ned No. of D!snwasners I Soace/Area Heating KW DetectionlSoundinc Devices Heating Devices KIN Local r j Municibal D aMr No. o. Dryers 9 L_. Connection No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts. Wiring No. Hydro Massage Tubs I No. of Motors Total HP I OTHER: INSURANCE CO%/ERAGE: Pursuant to the require"ents of Massachusetts general Laws I have a current :.lability Insurance Policy ineludir' :�bmotet d Operations Coverage or its substzntial ecuivalent. YES Q/O D I have submitted valid proof of same to the Office. YEF it NO C If you have cnecked YES. please indicate the type Of Coverage by checking line appspKate box. INSURANCE IV BOND O OTHER D (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Star: Y-3 D- f s- inspection Date Requested: Rough Final Signed under the Penalties Of perjury / 133-12 A FIRM NAME Yi1 t� �• I� ,ENh t,A 2L+ ' LIC. NO. Licensee Wi I{ i Awl T• -14%%m47 L Signature Z-1 UC. NO. S7 . S/ • orGl� �� • IM �. Bus.Tel. No. 978-b lI'lQ-73 00 Z Icy • Address Al:.To,. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nes have the insurance coverage or Its substantial ecuivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirernenL Owner Agent (Please check one) Telephone No. PERMIT FE`S (St uxe of Owner or Apent) x,8565 ....f 4 t Of,NCRT�1h'O TOWN OF NORTH ANDOVER A PERMIT FOR WIRING a i i • O'�gt�0•�„1' Ui CNUSE� r.. This certifies ..... �--_ -� . .................................. has permission to perform r .�....�...-..:: :"!. .... wiring in the building of:..: ' ?'-� ......................... 0 at.... ........................ y .................. ,North Andover,Mass.. Fee X( ....... Lic.No !2 ........(�.................... ........................... ELECTRICAL INSPECTOR I WHITE:Applicant CANARY: Building Dept. PINK:Treasurer . n�Ya i+YYYOY , ►g( t or TypeD .y�..owdee�a t� u" VIZHMIl IU IJU OMSFITTINQ l Print Il NORTH ANDOVER, Maas. Date G Gf 3 99 E ®uiidingl Location C'oA e,( 4,w S LANE Permit #D a 24-k Ant&UE(Z Owner's _ Name New ❑ Renovation p Replacement C� plana Submitted: Yea ❑ No x fA - hx c h w 0 v of h >: M x O F. t It eft' 0 AO10 H tlr0 !d x O ed a , lop 0119 30 MAt3gMgNT 2 + 1ST FLOOR IG#®.FLOOR t BRD FLOOR '. 47HFLOOR GTNFLOOR ! ®TN FLOOR 8TH FLOOR ► + -E ®TN FLOOR +. 1 .7 Check one: Certificate ins9afiing Company Name_(Ik)IoN LO El'Address 4� , N c/2 S''fee ��11 Corp.. Partnership We LL ,q,4 SS. 0,(&-j [1Firm/Co. Business Telephone�0 S3/O G Name of Licensed Plumber or Gas Filter INSURANCE COVERAGE: Check ops I have a current liability Insurance policy or Its substantial equivalent. Yes Ll No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy [!r Other type of Indemnity d Bond ❑ " OWNER'S INSURANCE WAIVER: I am aware that the IIcenseGAQ9tjLojhgM the Insurance coverage required by Chapter 942 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: nature of Owner or Owner's en ' Owner 11 Agent 11 I hereby certify that all of the details and Information I have submitted(or entered)In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under theued for this application will be M compliance with all perUnenl provisions of the Massachusetts State Gas Code and Chapter 142 ttr® al Laws. Tof Ucenso: , YV Plumber n e o nae m uor or as rille TRIO Gasfltter Master Ucense Number 306,0 �'�� VJoumeyman APPIPIOVED(OFFICE USE ONLY) �� 7 Date. . .�. .�� . �. .��. . s NORTH TOWN OF NORTH ANDOVER Of t1�EO 16, 0 F� ryt. op } PERMIT FOR GAS INSTALLATION SSACHUS�t This certifies that . . . . . . . . . . f. .�. . . . . . y. . . . .' . has permission for gas installation .'. . . . . . . . in the buildings of . . :. ... . . . . . . ... . . . . . . . . .�. . . . .. . . . . . at . . . .�. ' . . .. . . . .-. .. . . . .. . .`. . .. North Andover, Mass. Fee. ' .( . . .—Lic. NO...... ... _ . . . .l.vs.I !: . . . �:. . . . . . . r: . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File Date. .�.. . . . . . . . . . .N° 4416 0'. �c TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING • o �J ,SSAcmus This certifies that . . . . . . . . . . . . . . . . . has permission to perform . .. . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . .. . . . . . . . . . . . . . . . j at. . . ." . . . ... . :. . , North Andover, Mass. Fee° °".. . . . . .Lic. No.1 `�7. . . . �� .1?. . . . . . . . . . . . . ' PLUMB! /INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING oZt3 (Print or Type) Ow"91IN 0 �ID cI , Mass. Date 19 Permit Building Location (n I COIN G i-"M f\N S W U er•s Name Irl 4N C,ef-A A Ee,M O M,/P, Type of Occupancy 5 D E ti ti A V ♦+ New ❑ Renovation ❑ Replacement 2 Plans Submitted: Yes ❑ No ❑ FIXTURES z = of a Z Y PF- N N • N J N O Z WY J N :0- Q a N O ¢ N Z N Q ¢ Q = ~ y = O Z N a J N W 0 W W N h- V W H Y < H W Z a X_ V ¢ m X ¢ Q f- y Z ¢ a a a - < ¢ W O O ¢ < N ¢ 3 a W y O J = cr. a Q 0� U. W < = 3 O Z = Y d Q ~ a Y Q W k 3d W F- V � !- O 2 0. N �' Z O O N Z Z 0 W �' O 0 S < f- a e s N 1 (0 a a 0 a J J < ¢ ¢ a a 0 < a s 's r= m o SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR I It 8TH FLOOR Ir stalling Company Name k t3Ee-r o� - .',4(r m 4'T A e-7 Check one: Certificate Address �� C(:4 C H Mt4 n) a P J ❑ Corporation IV E Twi' e:-A) al A ❑ Partnership Business Telephone Z-iq-7 ! 9-A- /Co. Name of Licensed Plumberr'v3 INSURANCE COVERAGE: I have a current I bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please/indicate the type coverage by checking the appropriate box to liability insurance policy ld Other type of indemnity ❑ Bond ❑ ;OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by ,Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner [--] Agent[I I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum ' g e and I apter/11 of the eral Laws. BY Title re of Licensed Plumber—' CftyfTown Type of Ucense: Master % Joumeymab ❑ APPROVED OMI—C U ONL Ucense Number �3 3 5 as .. BELOW FOR OFFICE USE ONLY I FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR " 38 .' 5 Date...... NORTN °`<�``°;•�"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ITS MU This certifies that .......... ..:..1 .:...1.........'..,-.c........0�.P ............................ r r has permission to perform ...........I......(............�..`� ..................................... wrong in the building of...........1 a/**`./.1...eLLt)........................................... a at........ ...... ,North Andoveh �s. Fee... .1............. Lic.No.0 h P ............-�.^.-.......1.. ................. ELECTRICAL SPECPOR Check # Commonwealth of Massachusetts Official Use Only-, Department of Fire Services Permit No. 5 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C;/�C 1 .00 (PLEASE PRINT IN INK OR TY ALL F RM TION) Date: Q City or Town of: To the Insj�evcfor o Wires: By this application the undersign gives tice of h' or her intention to perform the electrical work described below. Location(Street&Numbe ) Owner or Tenant ( AC&D Telephone No. y — L�3 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps i Volts Overhead U Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system e Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA o.o me No.of Lighting Fixtures Swimming Pool rnd.Above ❑ In-rnd. ❑ Batte Units rgency Lighting No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting in Devices No.of Waste Disposers Heat Pump Number Tons I KW No.of Self-Contained Totals: Detection/Alertin2 Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection " Heating Appliances Security Systems: No.of Dryers 1; pp Kms' No.of Devices or E uivalent No.of Water K`,�, No.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electri al Work: (When required by municipal policy.) Work to Start: � Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the Ppainlslan d pen alties ofperjury,that the information on this application is true and complete. FIRM NAME: Ser�dcesLIC.NO.: 1 5_1_1(, Licensee: John S. Bassett Signature LIC.NO.: 1533C (Ifapplicable,enter"exempt"in the licensenumberline) Bus.Tel.No..• 608 594 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Li*see see 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 Signature Telephone No. PERMIT FEE: $ s Location CB t C o ���wt A►y C �� �. No. ~ Date10 a3'Otf MORTh TOWN OF NORTH ANDOVER O F � A i • : Certificate of Occupancy $ "Arlo A Building/Frame/Frame Permit Fee $ ! J s�CHuse 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ sa.-^-- Check # 17023C --- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING M OTHER THAN A ONE OR TWO FAMILY DWELLING X s S e c t i o n fo r Off c i a I USC 0 n I yl,15-, lMlk BUILDING PERMIT NUMBER: 41oo DATEISSUED: t—a,3 -4 Z SIGNATURE: Builft Commissioner/laTector of Buildings Date 1.1 Property Address: 1.2 Assessors Abp and Parcel Number. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage(fi) M 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWmd Provided 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public private D zone Outside Flood Zone 0 Municipal On Site Disposal System 0 0 2.1 Owner of Record C k&A 44 pug Law 0 Name(Print) Address for Service: 0 G85-09(16 M Signature Telephone 2 Authorized Agent mrrti 2-S-e e fWlait+�� > Z Name Print t Address for Service: 0 — MWA 9 ??— Z Signature Telephone M 3 Licensed Construction Supervisor Not Applicable 0 Attk Pcwrtr' 0 &PT Address License Number 0 Licensed Construction Supervisor: k06 > /? 3 1� 9)00 W–'yq8? Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name" Registration Number M eta Address t PIL?AExpiration Date Z A Signature Telephone i I, ,as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury yWk �Q ' Print Name ?IX1444 P340 Signature of Owner/Agent Date NOW �0;L Item Estimated Cost(Dollars)to be Completed by permit applicants 1. Building (a) Building Permit Fee Z 7 0( ) Multiplier 2 Electrical / (b) Estimated Total Cost of b 000 Construction from(6) 3 Plumbing Building Permit fee (a)X(b) 4 Mechanical(HVAC) �}, l 00 mo 5 Fire Protection Goo 6 Total (1+2+3+4+5) Check� 000,00 Nb � NO.OF STORIES Z SIZE BASEME R SLAB SIZE OF FLOOR TIMBERS i ST 2 ° 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING O SOLID R FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Icn t slrzcrox aQtlt©fir 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 Yea.......❑ No.......❑ SEM. ON 5-TRO]MUSIONa Ono A $, D�t�S �►"�Ott 11��+IrQI"�3'A�[�MQ �'ItQ` ,t ���bF'l +fv'3.�1STI)�A ,= 5.1 Registered Architect: 7" G�2lSUQL� Name: Address Signature Telephone Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date Name Area-of Responsibility Address� Registration Number Signature Telephone Expiration Date , Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 3 g f '` 6DMT1`A46 Q W L av, Not Applicable ❑ Coml43%tty Name Responsible in Charge of Construction .5;1�'+�'!`� ,+��`�,�'��#�►N �'PI�Q; ) fid€! {mak>all,a�pl��ablc�. 09 New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition - ❑ Other ❑ Specify Brief Description of Proposed Work: RO 'J Ti2 6�477i 1 Erni©lh cyJ eTl� SrMM G, �� k:�� _ a ,w (� id ate, ��i1„dyw lo�R CI) 'Si�rG �dac � ✓1 ", UM USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 ❑ A-3 ❑ IA ❑ A4 ❑ A-5 ❑ 113 ❑ B Business ❑ 2A ❑ C Educational ❑ 2B 0 F Factory ❑ F-1 ❑ F-2 ❑ 2C 0 H High Hazard 0 3A 0 IInstitutional 0 1-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R residential ❑ R-1 0 R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 0 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Height ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property Hereby authorize to act on My behalf,in all matters relative two work authorized by this building permit application Signature of Owner Date a The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 �9 Workers'Compensation Insurance Affidavit Name Please Print L c Name: / Location: �(' (oa(� t city Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity E�d I am an employer providing workers'compensation for my employees worldng on this job. Comparry name. (/0 3 Address car. *. G 82 Lr 9?R l '3Jl7rcl c�� Poli V WC Insuranceco. cv# o Co-� Company throe• Address Phone*' insurance Co. Policy_# Paikne to seeme coverage as requiredunder section 25aA or MGL 152 car lead to the irrpm"aFcximieral penalties.of a fine d s};sa anNor one yearsirnpm ment as co47 Ren ies��eSoms a IDP 1�ne�f(,311ao Q���si agent�. understand that a copy of this statement may be forwarded to the Offx:e of imrestigaft s of the DIA for coverage vend catldn. db hemby caertdy undar Me pains'and pens of perjury mat the infcrnraUm provided above is true and comeed l Signature Date Y✓112r r Print name i`�� Pie.# �I����c�2•�(�'PZ Official use only do not write in this area to be eornpl Ct by city or town otticiar Gr y of Town F'erud&1cerWrra.. Baffing-DOW []Check I J mnetfiate response is reguiraed -0 tensing Boal Q S%ctrnaft 0, Contact person: Phone# E] Health Depart! Other Ratte' Construction Co., Inc. 252B Pleasant Street Methuen, MA 01844 Tel. 978-682-4982 RESIDENTIAL CONTRACT AGREEMENT Read this Agreement and make sure you understand it before signing it. This Agreement has legal force and effect and binds those who sign it. Note: All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration provisions of Chapter 142a of the General Laws, must be registered with The Commonwealth of Massachusetts. Inquires about registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton Place, Room 1301,Boston,MA 02108. This Agreement is made on 01/20/04 between Ratte' Construction Co., Inc. of 252B Pleasant Street, Methuen, MA 01844 (978)6824982, hereinafter called "Contractor" and Charles and Susan Papalia, 61 Coachman Lane, North Andover, MA 01845 (978) 685-0916, hereinafter called "Owner". L DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following: Remodel residence as per plans drawn by Jane Griswold. IL DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performing the above described work consist of the following: As per plans drawn by Jane Griswold. III. PRICE Contractor agrees to do all work described on a cost-plus basis. Materials at contractor's cost. Subcontractors at contractor's cost. Carpenter's labor at $40.00/hr. Total of all above plus 21% overhead and fee. Projected cost approximately $150,000.00 HIDDEN CONDITIONS AND NECESSARY ADDITIONAL WORK Hidden conditions may require adjustments to the contract price. In such a case the contractor will inform the homeowner of such condition forthwith and where necessary a written amendment of this contract will be negotiated and executed by the parties. IV. PAYMENT Payment will be made as follows: $15,000.00 upon signing contract. Progress payments will be periodically billed. $15,000.00 deposit will be credited toward final invoice. Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special delivery materials,and equipment,whichever amount is greater. V. COMMENCEMENT AND COMPLETION OF WORK Contractor will not being the work or order the materials used before the third day following the signing of the Agreement, unless specified here in writing. Contractor will begin work on or about January 26,2004. Barring delay caused by circumstances beyond Contractor's control, the work will be completed by March 26,2004. The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. VI. NO ACCELERATION OF PAYMENTS BY ESCROWING ALLOWED The Contractor may not require payments to be made in advance of times specified in Section IV(Payment)above for reason that he deems himself or the payments to be insecure. If however, he deems himself to be insecure, he may require as a prerequisite to continuing the work described herein, that the balance of the payments under this Contract that are in the control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. VII. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself, his employees or his subcontractors in the performance of, or as a result of, the work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. VIII. SUBCONTRACTING Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third parry, Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. IX. CONSTRUCTION-RELATED PERMITS The following construction-related permits will be necessary in order to complete the scope of work included in this Agreement: Town of North Andover building permit. The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction-related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. Notice: If the homeowner obtains his own construction-related permits for the work described under this Agreement, the homeowner is hereby advised that in the event of a dispute,judgment and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A,M.G.L. X. MODIFICATION This Agreement, including the provisions relating to Price(Section III)and Payment Schedule(Section M, cannot be changed except by written statement signed by both Contractor and Owner. However,cancellation by Owner is allowed in accordance with the Notice of Cancellation(annexed). XI.WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 Year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed- upon work. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment, which shall be and are hereby passed through directly to the Owner. Under such manufacturers' warranties, the Owner may be required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. 3 This warranty gives the owner specific legal rights, and owner may also have other rights which vary from state to state under Massachusetts law, sales of goods carry an implied warranty of merchantability and fitness for a particular purpose. XH. COMPLETENESS OF AGREEMENT FOR EXECUTION The owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits or referenced documents that are incorporated herein are attached hereto. XIM COPY OF AGREEMENT TO BE GIVEN TO OWNER This Agreement is governed by the Laws of Massachusetts. It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal. RIGHTS TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than an address of the Contractor which may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of this Agreement. See attached Notice of Cancellation. Note: This proposal may be withdrawn by us if not accepted within 30 days. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Owner's Signature Date Signed Owner's Signature _ i�% -.---- Date Signed Contractor's Signature 't%1-/'a Date Signed c%j(0 c10RTH Town of ? ` Andover0 f No. y G o ----------- - C% -= - dover, Mass., a 3 O COC MICMEWICK. V S'RATE D a'Pa�,�S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... ... ... ... �........�.....................................�........................................................................... ........ Foundation /► iV has permission to erMt. r..�....... buildings o ........ .................... ........... ... Rough to be occupied as � .�,�..4.....r �.....1 ���'� Chimney ...........................w...... ...t�........................ ...... 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 B -Laws rel ting to the Inspection, Iteration and Construction of Buildings in the Town of North Andover. 3 � 1 a3 I PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO WT Rough .................................:....:..................: Service 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. Burner Street No. SEE REVERSE SIDE Smoke Det. .