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Home My WebLink AboutMiscellaneous - 647 WAVERLY ROAD 4/30/2018C) m Location No. Date 4, TOWN OF NORTH ANDOVER Certificate of Occupancy $ rs Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspecto �y 1. 1 Property Address: Gq ls,�f R, k 1.2 Assessors Map and Parcel OZ -7 Map Number Number: 00i i Parcel Number N9,q 5 1.3 Zoning hiformation: Zoning District Proposed Use 1.4 Property Dimensions: LA Area (sf) Frontage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard ReqWred Provide Required Provided Required Provided 1 1.7 Water Supply M.G.L.C.40. 54) Public 0 Private 0 1.5. Flood Zone Information: Zone — Outside Flood Zone 0 1.9 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERStUP/AUTHORIZED AGENT 2.1 Owner of Record - enrq Lo-'% r (,,4Y7 Wovt r Name (Print) �J Address for Service : 07of Record: �P%jt K - /ia e r, cw � A . v -t -� rt . t L�a-j = MM��Akikvffi�=WW�Jffg ( � r- V-,?- C-.5 Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed ction Supeervi License Number nse Num r Add Z 0 7 xpi ti; Sigrture Expiration DXa 3.2 Registered Home Improvement Contractor Not Applicable 0 Aom� - �)Q ;�O-� I c Company Name - N 1� IZ6853 6f tS�,� Registration Number Qktvj C) 0 ess cau�-a.o Expiration Date 1 SECTION 4 - WORKERS COMPENSATION (nG.L C 152 § 25c(6) I 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 buildi�E permit. Signed affidavit Attached Yes ....... V' No ....... El SECTION 5 Description o Proposed Work (check applicabi New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify '\-1% Brief Description of Proposed Work: V� UJ i\ a W S n C) r U CJ 0 r C4 rN SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant �411'1"--O Maw k, I . Building 361-7. (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) Mechanical (HVAC) .4 5 Fire Protection .4 6 Total (1+2+3+4+5) 06 ± t3%E Check Number IOR TION -T SECTION 7a OWNER AUTHOR TION TOBE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, Pau as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print N 7vakkQ a. Signature of Owner/Ag�n—t I NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FELLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE oeparment Ot InaUstrial,41cciaents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affldavit Please Print Location: citV Phone 1-7�) -'qSrJ am a homeowner performing all work myself. I am a sole proprietor and have no one working -in any capacity I am an employer providing workers' compensation for my employees working on this job- Compan� name: Q,�J 0 -� OD L rV SIC) C) Cn- c, \� -4-,V k a r.if%f, . 4� \ Cl\. I �-� a-)�. Phone #- � �)oo) C) 5 -7 --� 187— PoligY4' 7--oA2-b)c-coo7&53-cc ComRgn, name: Address City: Phone*. - insurance Co. Policy # Failure to secure coverage as required under Sectfon 25.A or MGL 152 can lead to the imposibon of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 4.do herby certify under the Print nam alties of pejjuiy that the inforination above is true and correct. Official use only do not write in this area to be completed by city or town official' E]Check if irriniediate response is required Building Dept Contact FORM WORKMAN'S COMPENSATION Date /- L4�O I . Phone #L5-0-6) 73-6-6496 I 11 Building Dept C] Licensing Board Selectman's Office E] Health Department 11 Other Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 1,26893 Ex'plilt'lon' 0�103/2002 Type: Supplement Card Home Depot At -Home Services PAUL VENTRE 3200 COBB GALLERIA pKWY #26 ALTANTA, GA 30339 Administrator im E CERTIFICATE OF LIABILITY INSURANCE Swisl X A 1339 THIS CERT11FICATE 16 1"U10 AZ A MA'nU Oir INFOIWATIC $HEPM & SCOTT CORP. ONLY AND CONFIRS NO MOM UPOIN ME CERIVVAl I I HOLDER. THIS CIRM"Till OM NOT A 0, aXYMNO 0 I362 UnANTH AVENUE - SUITE $06 ALTIER INE, CQVMOfA A"MM JY, THM eq&IM "L0% NEW YOFK NEW YORK 10001 INSURERS WOWNG COMAN GREKT AMERICAN INGURANIC9 COMPANY R#AA HOME SERVICIES, INC. AMERICAN ALTERNATWE INSURANCE 00, 3200 0080 GALLERIA PARKWAY ATLANTA, GEORGIA 30339 L I --- --- T HE POL IC199 00 IN"ViCt L13T ED OF LOW KAVk Ill E N ISSUED 10 THK IN SURE 0 NAME 0 ASOVE. FOR THE POUCY PERIOD INOICATW. NOTWTHOTANOOK, ANY REGLARfMeNT. TIRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VATH RESPECT TO V*QCH THIS CIATIFICATI MAY 09 )$"0 Of mAy PWAiN, TmIE jNWAAME AFFORDED SY THE POLICII63 DESCRISE0 NEREIN 13 $WSJEC7 IOALL THE TILRMS, IEXCLUS*N$ AND OONDffg" OF WOk VOUCIE& AGUEGATE LIMITS SHOVO4 MAY HAVE SEEN RMCED BY PAID CLQMS, A rM OF MOUPAMX "OPAL UNNUTY CWdftll�L 010M4 wsu7y L --'*Wt* CLAM WM 'A- PoLcy Wmit PAC 9M938 03/1060 lit, 03/10JOI 14HOOOLMNIMI s i Ll�qojool P" ft" ftM-A!L I $001 pollSOW& 4 Aw pumv 11 1 00 �a Aoaft"rd GIN% Aa""?t uwT AMA& MI. X PaLcyr—ira, f7l= 00~ me 1,000,00 A XIHMO X UA"M AWALM AU OVOW AV" c"Im"WAU" AVr0A MMM4%"* AUT% CAP 9026937 0311010D 031iojoi :10 460m,04WWA uw'r 4AAW 6AftJrf AW AM *Aftd*0-lAA*0I0W 6 ovarv. IA AM I A LNONE AXaM UAALM OWAA mA"mAim UMS9026938 03/10/w ovioml 10,000.00 0 _Iwo a 00APMArIOW AW ZW WC 0007353-00 oyloloo oviom xl=1 WMAIIII'mw i- 100,004 ; ouc%prm OF 0ftAATmom%4"md* 4 ma lummicumKx" *,oma ey pwpAswoo CER'nFICATE gar vjv.AwZ wsumst urym, CANCELLATION e!ej- PROOF OF INSURANCE 30 VAnVAll "o"m To rig co"MA" Ham WAM to We I^ an "AM vo be do a" I voVa W Mi"TWO a% UMOM W AW IM ~ "ff MUW% 0111 AMM C A�fllkl*ft= 9z to Cf) 0 or. r. 9 x u Cd r. x 0 cu r. u u r. tv WZ CR cf) -NO OE C/) 0 C3 C.) CL mm CA r= CC CF CD 0 CL C43 cc C.2 0 .4 - cm c L CA m ca COD cma C113 'W ca E cmec o c ce C 0 z CCIL CO3 CLO - 14D s co, 0 .2 M.= CD ra AD —M to CL-= E .0 00 (cam CS .CL 40D :2 0 :a Go = zip CO) m0 em .5 CLO. 44 0 :9 7S CD 0 c" 0 cm z CD CD 5 0 4—) ,.a 4ZL. 0 E CD CD CL CO) CO CM ca M E CD CD CL CD CD ca CL cc C = a - C* cc CD CD CL w w (1) cr w w cc w w CO :g 0 0 4—) ,.a 4ZL. 0 E CD CD CL CO) CO CM ca M E CD CD CL CD CD ca CL cc C = a - C* cc CD CD CL w w (1) cr w w cc w w CO A Location / 'qj Z/ 9 / No. 633 Date 6119—P TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check # �A I 16469 $ 11?A (6-4�A-� ' Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUELDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: CQL�� Building CommissioEgjntEtor of Buildings Date SECTION I- SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning hiformation: 1.4 Property Dimensions: Zoning Di�—V ict Proposed Use (sf) Fromage (ft) 1.6 BUIIDE'4G SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provi&d ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHWIAUTHORIZED AGENT 2.1 Owner of Record /V/K 67-edleye 4,�qlpc> Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 0 2, Licensed CbAtruction Supervisor: License Number Address 41 /J;/a Expiration Date Signature Telephone 3.2 Rl�gistered Home Improvement Contractor Not Applicable 0 'y Com�aroame Is Registration Number Address 7k -6&F,67-?? Expirati6n Date Signature 0' Telephone T M z 0 I I Ni N 0 z M 90 0 wn ra M r rM SECTION 4 - WORKERS COMPENSATION (NLG.L C 152 § 25c(6) I 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 ....... 0 No ....... 0 SECTION 5 Description of Proposed Work (check A applicahii� r New Construction 11 1 Existing Building 0 1 Repair(s) 0 1 Alterations(s) 0 Addition 0 Accessory Bldg. 0 1 Demolition 0 Other 0 Specify Brief Description of Proposed Work: I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by 1jermit applicant OFFICIAL USE ONLY I Building (a) Building Permit Fee Multipli 2 Electrical (b) Estimated Total Cost of Construction Plumbing Building Permit fee (a) x (b) -3 Mechanical (HVAC) -4 Fire Protection -5 -6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AqKNT OR CONTRACTOR APPLIES FOR BUILDING PERMIT -� Agent o ubject property as Own��Au �orize Hereby authorize to act on My behalf, in all matters relative towork authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, .,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date Z NO. OF STORIES SIZE BASENENT OR SLAB SIZE OF FLOOR TMERS I ST 2 ND 30 SPAN DIMENSIONS OF SELLS DIMENSIONS OF POSTS DlTvENSIONS OF GIRDERS HE IGHT OF FOUNDATION THICKNESS SU -E OF FOOTING X MATERIAL OF CFMVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Location [,V,4 No. c:,2 0-3 Date 9, - TOWN OF NORTH. ANDOVER ,to " M., il +;.Ea Certificate of Occupancy $ MU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 'i 7658 cj�, Building Inspector ;0 - r" TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7 BUILDING PERMIT NUMBER: C;20 3 DATE ISSUED: SIGNATURE: Building Commissio!L��tor of Buildings Date SECTION 1- SITE INFORMATION 1. 1 Property Address: 1.2 Assessors Map and Parcel Number: IVA Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dia;ict Proposed Use Lot Area (sf) Froritage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 11 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System D SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT AC) r D rs t r i c, -tY,,� s 0 2.1 Owner of Record ;7 /A7 �,Cj W/ V Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Ad�t*:ess Expiration Date Sigfiature Telephone T M X z 90 0 "n ic M z G) SECTION 4 - WORXERS COMPENSATION (nG.L C 152 § 2! Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... 0 No ....... 0 SECTION 5 Description o Proposed Work (che"ck appUcable) New Construction 0 Existing Building 0 Repair(s) 0 0- , % this application. Failure to provide this affidavit will result Alterations(s) 0 1 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: Z S-�-� 4��l / A Ir V. - I SECTION 6 - ESTIMATED CONSTRUCTION CORTR I item Estimated Cost (Dollar) to be Completed by pennit applicant 0 MCIAL USE ONLY I Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction -3 Plumbing Building Permit fee (a) x (b) 14 Mechanical (HVAC) -5 Fire Protection .6 Total (1+2+3+4+5) Check Number bEt-iiun iaVWAEKAU1HUK1LA11UN 1U BE COMPLETED WHEN OWNER��J-Qy CONTRACTOR_APPLWqOR BUILDING PERMIT uthorized Agent of subject property as Owner/A t—eby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature ofOwner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name of Owner/ Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2Y415 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GII�DERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHFVMY IS BUILDING ON SOLD) OR FILLED LAND [-IS BUILDING CONNECTED TO- NATURAL GAS LINE Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542. Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Ad "HOMEOWNER A,� q Nanie Home Phone PRESENT MAILING ADDRESS 61 " /'-' a -r 0 10 frLr 10"/'C.? I :j -'f J_ Map / lot Work Phone . I City Town State Zip Code The current exemption for "home6wneriCwas extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5. 1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which heJshe resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulaWns, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and th he/she comply with said procedures and requirements. -Op* 7 HOMEOWNER'S SIGNA APPROVAL OF BUILDING OFFICIAL 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 - Workers'Compensation Insurance Affidavit Name Please Print Name: Location: Citv Phone # F1 I am a homeowner performing all work myself. F-1 I am a sole proprietor and have no one working in any capacity F� I am an employer providing workers' compensation for my employees working on this job. Company name: Address , Cibc Phone #7 Insurance Co. Policv # Company name: Address Cily: Phone insurance Co Policv # Failure to secure coverage as required under Secd n 25A or MGL 152 can lead to the imposition of criminal penalties d,a fine up to $1,5W.00 andlor one years' imprisonment.as.well-as -civil.penalties, in 1he fam dA..STOP.W.ORK-ORDER.,arid..a.fine.of.(.$100.00.) a day against m. e. I 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 under the pains and penalties of pedury that the inthrmation provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town ermit/Ucensing Building Dept rICheck if immediate response is required Licensing Board Selectman's Office Contact person: Phone Health Department E3 Other 4 1 . 1� cn m m x m m x Ch m m C2 rom POO Cie CO) MZ CD 06 CL:q. C-) CD CD CL cr =r "C CD P-0 M Er Mi CD 0 CD cm w —3. CD CA CD CL C2 Cos 0 CD CA 10 CD z CD CD C/) C/) n 0 z C/) z M �*-c =r c 2:-% 0 Go cr In a CL Ste a C.) co C.) CL m CD r— m z =r -o CL. -O CL 0= m co I .1 -- 0 0 6*4 :1 co Z dc 0 0 CD c =r CL 0 a In Cos CD CL CD In =- 0 C441 L Or cr-r e. CL CA ft. - COD a CD. Cos: 46 cws 0 CD ca CD: COD: wo 90 CLM: 0 CD: 5* cn R 0 cn R z oo��*.!4 - m 0 EL 0 EL Pod -A m x 0 . C40 z EL n 0 et qi 8 tz e Ps �Ti rb 0 OZ 0 2� 0 0 9 Wl 0=3 0 9 0 PMK (At -4(% a or 0 oo��*.!4 - 0 -A m n)� < (At -4(% a or 0 A.J. Walsh & Sons Inc. Mass. LICENSE'# 022691) 55 1"Icasaw Sirccl Nordi Andovu, MA 018A5 Xi,'%s REGISIVATION // 10.3.1,59 RESIDEN77AL CONTRACTING 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. Notice: All home Imp rovement contractors and subcontractors engaged In home Improvementcontracting, unless sptclnca I IV exempt from registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth' or Massachusetts. Inquiries about registration and status should be Made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: Registration Number: Salesperson's Name: T'his agreement is made on (11 / / (ADDIdiSS) hereinafter called "Contractor" and hereinafter called "Owner". DETAILED DESCRIPTION OF WORK TO BE PERFORMED — &do' —& (RIONF. NUMBER) (PIIONE NUMBER) DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in perfprtnin; the, above descrj�bedwork consist of the followine: U. PRICE 9— Contractor agrees to do all work described in Section I for the total price of S_ W. PAYMENT Payment will be made as follows: 13 3 1 /11 % (S cZ00, upon signing Contract; upon completion of_; (S upon comple6on of and the rcmaininl-� �6d% (S )upon verification of the work by Owner and Contractor a;�4�vg been sulmisfactorily completed, which verification shall take Place PtOmPUY after completion. Notice: N - 0 agreement for home Improvement contracting work shall require a down Payment (advance deposit) ofmore than one-third of the total contract price or the total arnount of all deposits or payments which the contractor must make, In advance, to order 2nd/or otherwise obtain delivery of special order materials and equipment, whichever amount k Lreater. IV. COMMENCEMEN7 AND COMPLETION OF WORK Contractor will not begin the Work or order th *aI fore the third day following the signing of this Agreement, unless specified here in wnitins. Contractor will *In the w Tk o or boor edatc). Barring delay caused by circumstances bcvund Contractor's control, the work -ill be completed by (dalc).'The 06-n�r-hcrcby acknowiedges and aRrecs that the scheduling 'dates are approximate and that such delays that are not avoida le by e Contractor shall not be considc, ed as violations of this' A;rccmcnL V. NO ACCELERATION OF PAYMENTS IIUI ESCROWING ALLO"11) The Can tractor may not require paymcnLs to he rox,JI: I I I ii,dVance of:he 11 fries specified in Sr, imo I I I (PsYmen 0 a hove for there"on that hc deems himself or the payments to be insecure. If. however. fie deems lilnl.%clf III tw. In.%ccurc, he may require. LN 3 Prerequisite In continuing the work described herein, that LIM hal firice of the flaymenti, under this comin( I I hat air. m it," - I'lloil (If. IIIV Owner h1lall W- phit ril inn illiol ricro- account that requires tire signature of both the Contractor and Lhe Owner for witherawal. V1. INSURANCE Contractor will be. rmprinsible to Owner or any third party fmany property &Imayc or bo,li ly III jury caused by himself, his employees or his sul-iconvactors in the performance of, or as a result of, the work under this AgccmcnL. Contractor agrees to carry insurance to cover such damage or injury. VU. SUBCONTRACTING Contractor agrees that, notwithstanding any arrcement for niaierial.� and/or labor between Contractor and a third pany. Contractor is res i c 00 c for comple6on of -all work described in a 6mely and workmanlike manner. pores hl I wn r Vill. CONSTRUCTION.Rl-'LATI-'1)1)1.'Rtvll'l',� The following cmstrucdon- related permits will'bi- I necessary in order try complete the %colic of work included in this Agreement: I The Contractor under provisions ofChaptcr 142AofLhc General Laws iSTCquircd to apply forandobtain all construction -related permits. The Contractor shall not be deemed responsible for delays in Lhc work described in Lhis Agreement caused by regulatory, permit gTan6ng or inspocuonal agencies, authorities or individuals. Notice: ir the homeowner obtains his own constructlon-related PUM16 for the work described under this agreement, tile homeowner is hereby advised that In the event of a dispute, judgment and nonpayment or the contractor, the homeowner will not be entitled to make A C121M to or collect from the guar2nty fund established by Chapter 142A, M.G.L. IX. MODIFICATION This Agreement, including the provisiuns relating to price (Section 11) and paymcni'schcdulc (Section 111) cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation (annexed). X. WARRANTIES The Colaractor WW731115 U131 thc work I kirni-01"ll IIVI MOO 111;111 be I I cc If tim defects in owici lal:- and workmatishill for a pet iud of following completion and shall comply with dic requirements of this Agreement. In Lhc event anv defect in Workmanship or materials, or damage caused by the Contracior, his subcuntraciors. employees or ageilLs. is distilvered within one year aftcl"COmple6un of anyjob. including cleanup. Uic Contractor shall. :11 his own expense. forthwith remedv . , repair. correct, v -place, or cause ui he- remedied. repairc(L or replaced. such damage or such defect in materials or worKmariship, foregoing warranties shal I survivit. an v insPI-vt I# Ir —rform�! in co—ei-tiorl w It uIr P!or j.ij, r wo- I h P no k. All warranties fo . r equipment supplied by the Contractor under I.his Agreement shall be. those given by Lhc manufacturers of such equipment. which shall I)c 'Jill Me hcIrh% pnv%rd thiough direvil ' y I,) III,. io,lcl %it, 11.1'allufaclul cfs' will Ihr Owner may lie required 10 icgisicror mail in 41 wW7LLnly 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, u Wch failure voids the manufacturer's warianty, shall not create any rcsponsibiliiy fur the Cuntractor to warranty such equipment - This warranty gives the owner specific legal rights, and owner may also have other rights which vary from sLitc to state. Under MassachusCLLS law, sales uf goods carry an unplicd warranty of mcrchjnlal)ility and fitness' fur d 1,artICU1.11 purpo�c. XI. COMPLFTENESS OF AGREEM ENT FOR EX ECU11 ON The Owner is hereby advised that he should not sign this Agreement unless and unul all bl"- sections have been filled in or marked a -s void. deleted or o0I applicable, W until all exhibits and relaled (,I referenct-d documents that are incorli,mijed herein arc attached hereto. X11. COPY OF AGRI:FNJEN'T TO BE GIVEN TO OWNER 'flus Agrecnicni is govcmed by the Laws ol Massachusetts. It must be CACLuted in duplicate. and an original -signed copy hcrcof given to UicOwncrat [lie liole of execution. No work undirr the Agrevinent shall N -gill prior to the signing (if Uie Agreement and tf-insminal to the owner of a Copy thereof. RIGHTSTOCANcri, — The owiter may c3ncel thisagreenient if i(has been signed by (lie ownerat 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 br rich by ordinary niail posted, by (clegrain sent or by delivery, not later than midn ight oaf tile third business day following the signing of this agreement. See attached Notice of Cancellation. 7 HOMEOWNER: DO NOTSIGN TI [IS CONTRACT IF THERE AR E A Y BLANK SPACES.) 41 Owne 's s ig7latille Date Signed DdLe S i &cd contractor s Signal e If G(-1 21M "2 The Commonwealth ofMassachusetts Department of Industrial Accidents office OU-7yestigatiolls 600 Washington Street Boston, Mass. 02111 city NO AW00 1161� phone # Q & Ef-,� 7,? n I am a homeowner performing all work myself. F1 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 C] I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the co ntractors listed below who have ... the following workers' compensation polices: tailure to secure MVerage as required under Section 25A of MCL 152 can lead to the imposition of criminal 11 penalties of a fine up to $1,500.00 and/or one years' imprisamiftent as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this stateatnt may be forwarded to the Office of Investigations of the DIA for coverage verification. Idoherebyce t amder the pains andpenalties ofperjury that the information provided above is true and correct. Signature= --,ate Print name_.Q7�//"d/0 U4c -,y )E? Phone# 9 17k-��a -CZ737 official use only do not write in this area to be completed by city or town official city or town: permit/license # — Building Department C] check if imwwdiiate response is required C]Licensing Board ClSelectmen's Office Cj-Health Department contact persom. phone#; —Other— (revised 3/95 PJA) 6 z m 6"), P� 0 CL -4 U :w u 0 CD C E CO r2 z 0 Im CA CD CO) CD b— CL Cl) CD Q cc r -'s CO2 0 .7 CO) 0 COO) r�mft-1 Z W CO ZM 0 CL) co 0 CO4-0 z C.) CD CL LLI C) C/) LLJ U) a: LU Lij tr LL) LLJ C/) Q) u 0 �2C: z V) cz 0 u w z 0 z Or - r. 0 cz C4 0 t —CIS 1% 0 u w u u �4 U) u w 0 CO z cn o E U) 0 CL -4 U :w u 0 CD C E CO r2 z 0 Im CA CD CO) CD b— CL Cl) CD Q cc r -'s CO2 0 .7 CO) 0 COO) r�mft-1 Z W CO ZM 0 CL) co 0 CO4-0 z C.) CD CL LLI C) C/) LLJ U) a: LU Lij tr LL) LLJ C/) C) U c.) L) ca m CA �E co ca E.S 0 CD C L M -0 ca ck C,* E . coo co 0 r -L C" co to rCm Zcm = C2 :2 - or ca, :0 m C>:, 'D CIO C', CA S LZ = 4- 0 ca Z CD L- 40 C.3 .0 C.) (D .9 Oo= COO) CL 0:6 cm CL.. Co 0 CL -4 U :w u 0 CD C E CO r2 z 0 Im CA CD CO) CD b— CL Cl) CD Q cc r -'s CO2 0 .7 CO) 0 COO) r�mft-1 Z W CO ZM 0 CL) co 0 CO4-0 z C.) CD CL LLI C) C/) LLJ U) a: LU Lij tr LL) LLJ C/) Date... r. TOWN OF NORTH ANDOVER PERMITTOR GAS INSTALLATION "7SACHUS* This certifies that-.- 21 tl,, ....... ..... ................ has permission for gVs installation . . in the buildings of t�. .. .... zz o, /�' No Andover, Mass. at ..... �/' rth .7 ............ ............. Fee.//.�-OLic. No.J.. GASINSPECTOR -Check 4920 MASSACHUSEMUNDORM (Type or print) NORTH ANDOVER, MASSAC Building Locations 7 ,C) <�'kAkpr-/ DU kr- Owmeris Name New Renovation Replacement �h 001��MX UNION Plans Submitted Date / /— S --o :�� Permit# Amount $ (Print or type) one: Certificate Installing Company Name— C-� - , Cff Corp. . 0 Partner. Phirm/Co. Name of Licensed Plumber or Gas Fitter (3 INSURANCE COVERAGE Ch:ect o : _s kin e Yes Noo I have a current liability Insurance policy or it's substantial equival nt. e X. If you have checked yes, please indicate the type coverage by checking the appropriate x. ,,Liability insurance policy [IT Other type of indemnity Bond 0 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 perniit application waives this requirement. Check one: � Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the cletails ana iniormation i nave SUDIFLIELM kOr eTILUICU) III dUVVE; dFF111-dLIVII 41C; LIUG aI1U dt-UMMU tV L11r, s 7� *tI ed for this application will be in best of my knowledge and that all plumbing work and installrai6ii iformed nder Permi ssu Stat�/Gas Co, compliance with all pertinent provisions of the Massachuseu d*ndfhapter 142 of the General Laws. 1 1 By: Title City/Town APPROVED (OFFICE USE ONLY) Sign )Kre of Li Plumber Gas Fitter Master Journeyman sed Plumber Or Gas Fitter nse Number M 6TH.FLOOR 7 T-5 -.F L 6-0 -R ,8TH.FLOOR mm (Print or type) one: Certificate Installing Company Name— C-� - , Cff Corp. . 0 Partner. Phirm/Co. Name of Licensed Plumber or Gas Fitter (3 INSURANCE COVERAGE Ch:ect o : _s kin e Yes Noo I have a current liability Insurance policy or it's substantial equival nt. e X. If you have checked yes, please indicate the type coverage by checking the appropriate x. ,,Liability insurance policy [IT Other type of indemnity Bond 0 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 perniit application waives this requirement. Check one: � Signature of Owner or Owner's Agent Owner Agent I hereby certify that all of the cletails ana iniormation i nave SUDIFLIELM kOr eTILUICU) III dUVVE; dFF111-dLIVII 41C; LIUG aI1U dt-UMMU tV L11r, s 7� *tI ed for this application will be in best of my knowledge and that all plumbing work and installrai6ii iformed nder Permi ssu Stat�/Gas Co, compliance with all pertinent provisions of the Massachuseu d*ndfhapter 142 of the General Laws. 1 1 By: Title City/Town APPROVED (OFFICE USE ONLY) Sign )Kre of Li Plumber Gas Fitter Master Journeyman sed Plumber Or Gas Fitter nse Number