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Miscellaneous - 665 OSGOOD STREET 4/30/2018 (2)
I� i Cunningham Lindsey U.S.,Inc. �Uxln lri 7 amP.O.Box 703689 n Dallas,TX 75370-3689 Lindsey Telephone(888)738-8714 Facsimile(214)488-6766 CLCAT@CL-NA.COM ***********************AUTO**3-DIGIT 018 783 T3 P1 95000058973 Building Commissioner or Inspector of Buildings 120 MAIN STREET N ANDOVER,MA 01845 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B 1 Claim Number: 2003512 16 Policy Number: 2003512 16 co Company Name: MERRIMACK MUTUAL FIRE INS fl. Cause of Loss: ICE DAM _o Date of Loss: 2/19/2015 0 Insured: DOUGLAS HOWE j Property Location: 665 OSGOOD ST Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 3$ No insurer shall pay any claims;(1) covering the loss, damage, or destruction .to.,a:building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss,damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code,to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however,that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 �, r Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Douglas Howe, Jr. & Janice Howe Property Address: 71 665 Osgood Street Policy Number: HP2003512 Date/Cause of Loss: 3/16/2014, Chimney Fire File or Claim Number: 29353-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner On this date I caused copies of this Notice to be sent h p e t to the persons named above at the addresses indicated above by First Class Mail. i Signa7MENT nd Date ANDERSON ADJUS CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 i I Date.z... ..... "ORTH TOWN OF NORTH ANDOVER .. WNW PERMIT FOR WIRING 'ry sSACMUS� Y es that .......-- his certifi . .............................. -; u: has permission to perform .... j z wiring in the building of.. ... .......... % at x ,North Andover,Mass. Fee-s�S.............. Lic. ......�... ELECTRICAL IASPECPOIt Check # v `� 7025 Commonwealth of Massachusetts Official Use Only s - Permit No. Department of Fire Services � Occupancy and Fee Checked &�s BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 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: 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) (j C.� DSC-0 0 0 7 l Owner or Tenant ��0 U G L� f ���w 1? Telephone No.7)/- V., -P26t3 Owner's Address Is this permit in conjunction with a building permit? Yes lJ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: w !.� G Ac AL e ,/)�)� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units j No.of Receptacle Outlets3 No.of Oil Burners FERE ALARMS No.of Zones No.of Switches Z No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number I Tons I KW No.of Self-Contained Ir Totals: Detection/ erting Devices No.of Dishwashers Space/Area Heating KW Local❑ unicipal ElOther 'Connection No.of Dryers Heating Appliances Kms, Security Systems:* No.of Devices or Equivalent No.o Water KW No.o No.o Data Wiring: lHeaters Signs Ballasts No.of Devices or E uivalent ' No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent s OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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. 1 CHECK ONE: INSURANCE L9' BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: �. / ov moo,—-4 1 r LIC. NO.:2 Licensee: X12 { lcw 7-,e--c-46.,f Signature LIC. NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: Cl.2-'C1/l/ Address: /23 S/ 4 y — /44 . o/pc 2 Alt.Tel.No.: *Security System Contractor License required for this work; if applicable,enter the license number here: 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. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ ��� r O , i . J i Date.. �....... NORTH TOWN OF NORTH ANDOVER 0 0 1 PERMIT FOR WIRING ACHUS Thiscertifies that ............................................................................................. ..... has permission to perform .......... .. wiring in the building of....... ................................................. at4.&...... ..... 5. .....................e.r.),North Andover,Mass. Fee60.............. Lic.No.177Y..w.e.............. 2 " Check # 6 860 Commonwealth of Massachusetts Official Use Only � Department of Fire Services Permit No. F018 7 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] 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: li'I jlj O 9 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) Owner or Tenant 091VTelephone No.A5 41VI Owner's Address MIAT Is this permit in conjunction with a building permit? Yes ❑ No DQ (Check Appropriate Box) Purpose of Building 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 rs i Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector Of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total k Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones +� No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices Tons g No.of Ranges No.of Air Cond. Total No.of Alerting Devices � No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ..... . .. . ......................................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: I Attach additional detail if desired,or as required by the Inspector of Wires. 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. t INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under t1je pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME:( LIC.NO.:�J�Lk Mk Licensee: D, Signature �QAr LIC.NO.: a9?:143C (Ifapplicable, ter "exempt" n the Ucen e nzonber line. Bus.Tel.No.:Cno5ffl 59413 Address: �(� rY P � l-n �[� Coote U'211 V/ *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: $ 66 Signature Telephone No. Date.................................. ti NOR7y 0 TOWN OF NORTH ANDOVER 10 . p PERMIT FOR WIRING 'SsACHUS QThis certifies that ...�..... .:........1! ....: � ...................................... has permission to perform .,... , — ..... E' r wiring in the building of... ..................... at .............-..`' r .-� ,North Andover;Mass. ......:2: ... .... .................. I, !/ S Fee...G.��........... LIc.No.��. ............ ELECTRICAL INSPE //,• ., r Check # 8389 Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No.- ?3 ff Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblmk) 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) Dater -Q& 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) 5� Q$(G&D sTft-E Owner or Tenant uHa--JeS Telephone No. ? Owner's Address ,SQ.VKa Is this permit in conjunction with a building permit? Yes ®• No ❑ (Check Appropriate Box) Purpose of Building MP- Utility Authorization No. Existing Service 100 Amps Q-12 / 2.f(0 Volts Overhead ❑ Undgrd No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,k k1&R% L e VAI o A o ti Completion'of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 30 No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ in- ❑ o.of Emergency Lighting rnd. rnd. BatteEy Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of.Gas Burners No.of Detection an Initiatin Devices No.of Ranges Total g ` No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump J.Number Tons KW No.of elf-Contained Totals: Detection/Alerting Devices No.of Dishwashers `�, Space/Area Heating KWLocal❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Sectio Systems:* Devices or E uivalent No.of Water No.of No.of Heaters KW Si s Ballasts DataNo.of evices or Equivalent I No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ( C1 (When required by municipal policy.) Work to Start: `j'3eI�-( 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 %I BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: T43c\A Gtr ti y( C rl� LIC.NO.: �rI�p Licensee: J-ctSGv, GtrAv,rydQ,w't t Signature LIC.NO.: ry (If applicable, enter"exempt"in the license n ber line.) G 5�l,lc+�s�e-)I �r-v1��y Sc .�r.,, y�� til � Bus.Tel.No.-_6 1 4-y �6SJ Address: Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$� • f d The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UF 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): -sCt S Gvi bi �M SVP SOv1d Address: o Sq 116o S J J1 SY City/State/Zip: :5c)eq i j ?CPhone #: CC T S Are you an employer."Check the appropriate It= a Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.;�,j am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling y ship and have no employees These sub-contractors have 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per'MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,❑ Roof repairs insurance required.] t employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy inform ation. I 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 an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: k1 c 4 4 l t j -1,5V V Q V C.Q CC,Ve, Policy#or Self-ins.Lic.#: ) C 3 Expiration Date: Job Site Address:_ (356ccio 5Tf�E E T City/State/Zip:_ /lJ 0v+� AV, cvp✓ 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: - Date: 3(n —06 8 Phone#: 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#: t r I I� I Date..:... . ..dg Of � OL TOWN OF NORTH DOVER �o PERMIT FOR $ INSTALLATION 9 SAC'HU'- This certifies that . .%. .�!`'' j./� G? . �` . . . . . . . . . . a. has permission for gas installation ;... . .:`.. .-.. . . . . . . . . . . . . . . in the buildings of . ., '. . . . . . . . . . . . . . . . . . f �?"` at . . North ,Annddover., Mass. Lic. No.1..3/v3/. >C.-� . . . . . . . . . . GASINSPEeTOR a Check# 6527 34 D/ MASSACHUSETTS UwxmM APPLICATON FOR PERM TO DO GAS FTrnNG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Loqations Permit# Amount$ -36 Owner's Name �Q New❑ Renovation 13Replacement Plans Submitted a rA Z) m x Cq y F d �' z z p rn C v v w r. y a C W d W v, .. C S p4 W z e w a .H. u m a o x fz e a < d c g z W c SU B-BASEMENT 3 O '� V > G off. F O BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLO0 RR 8TH .' FLOOR (Print or type) Name_ ►�-GL�L���^ t— Check one: Certificate Installing Company 4 ❑ Corp. Address © J�X p� D D� Partner. Business Telepgone Firm/Co. Name of Licensed Plumbeior Gas Fitter �- i INSURANCE COVERAGE I have a current liability Insurance,policy or it's substantial equivalent. Yes Check one: If you have checked Les,please i cate the type coverage by checking the appropriate box. No❑ Liability insurance policy Other type of indemnity ❑ Bond 13 1 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. Signature of Owner or Owner's Agent Check one: 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 installations performed unde ermit Issued for this application will be in compliance with all pertinent provisions of the Mass State Gas de � C apter 1 f the General Laws. By: Signature of Licensed Plu ber r Gas Fitter Title Plumber City/Town; ❑ Gas Fitter icense Number 13—master _ APPROVED(OFFICE USE ONLY) ❑ Journeyman ' � r Date. NORTp `i` i •°,;•�hoo4 TOWN OF N' RTH ANDOVER F PERMIT FOR PLUMBING SSA US r� This certifies that . . .� ,.� . .p1 . . . . . has permission to perform . plumbing in the buildings . . . . . . . . . . . . . . ... . . . . ., North Andover, Mass.. Fee Lic. No.. . . . . . . . .� . . . . . . . . . . . . . . . . �G INSPECTOR +Check# ���� ? 1835 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS / Building Locatio �j�0!'�ST Date Owners Name t �U!!�! U3 e— Permit# Amount Type of Occupancy New Renovation Replacement 'Eff Plans Submitted Yes 13/ No FIXTURES Z H U D o x oCn a A0 9z A A a W) to o V) o SLS) M HOQ2 M HOOR 3M HOCR 4IH H DM 51H R—CM 6IH Hit _ 7IH Hit SIH HOQt R (Print or type) Check one: Certificate Installing Company Name_ c�,� 1�y�('�fi 1(�, t Corp. Address Partner. ` Business Ldlephone PFirm/Co. Name of Licensed Plumber: 1 L►�Q /' Insurance Coverage: Indicate the type of insurance 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 three insurance Signature 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 installations performed u r Permit sued for this application will be in compliance with all pertinent provisions of the M c sett State P o e and C ter 142 of the General Laws. By: ign ure U1 jjL;UjjStCjrjUmj)L:r Title Type of Plumbing License / . City/Town / ,J.,icense 1NUMDer MasterJourneyman ❑ APPROVED CE USE ONLY cort '`"' ✓' ... • --aim / � � 2181 Date : .. / � s M NpRTM 9 TOWN OF NORTH ANDOVER- PERMIT FOR GAS.`INSTALLATIOW a l •�9SSgC�HUSEt .. a A This certifies that . / K0t!?. . . .t. . . .� • . has permission for gas installation . : ry''`':A/ . . . . . . . . . . . ... . . in the buildings of Tom" e . . . . . . at G C�.J. . . . . .. . . . . . . . . North Andover; Ma s. Fee. '. . Lic. No..L�1 J 3 . . . . . . . . . . . . . . GASINSPECT0 WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File MASSACHUSE , .UNIFORM APPLICATION FOR PERMIT TO OO GASFlTTiNG l (Print or Type) NORTH ANDOVER Mass. Date g kuilding Location d� Permit llf ' Owners Name New "1 Renovation U Replacement Plans Submitted �] -� FIX URE's N � W tff Z Q as m a m .o N s t�- w W o V m r os x as y "4 a r z o r w d 0] N N W W 1 O O Q w 4 a w t _ .- » y Uf o w - os o w W w m ; d ... a: a a w w v x c3 Cr }w N 0 Z o I.- w o U3 Z x d w e a m x a ,u > .a w 5 x d c d o o w o w f- Q x o .o = tL O -a u rr W a a t'- o SU$—BS4.1T. BASEMENT tST FLOOR 2HO FLOOR 3RUFLOOR 4TH FLOOR STH FLOOR GTHFLOOR 7TK FLOOR 8TH FLOOR 1 11 1 A Li (Print or Type) Check one: Certificate Installing Company Name ANDOVER PLG. & HEATING CO. , A . Corp. 2122 Address 57371 /2 SO UNION ST. Partner. LAWRENCE, MA. 01843 Firm/Co. Business Telephone: 508 685-8383 Name of Licensed Plumber or Gas Fitter GEORGE 1 AROSE I Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy (Other type of indemnity Q Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent El 1 hereby certify that aU of the devils and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and InrtAllations performed under,Permit issued [or this appUentioo will_be in campWnoe iritis all pertinent i provisions of the Massachusetts State Cas Code sad chapter 142 of the Cental L1ws. 13y YPE LICENSE: mat--- Plumber Sensed Title asfitter- Si naEure of Li Master Plumber or Gasfitt:er City/Town: Journeyman License Number APPROVED (OFFICE USE ONLY) I Date.... ... ................. x � NORTH o=°;t TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 16 ; � - SACMUS� �\ This certifies that ..................... ..�� �c .............. .... has permission to per fd � .4 !i' i - .. .�, .:... 1. ...'. .1�c��... ....... .: wiring in the building of � .,...... .................. at.!!/. ' 1 ..................................North Andover,Mass. Feer. .. Lic.No./'.�Ic....�......................................................... ELECTRICAL INSPECTOR 3heck # = % �K*11) 5345 Commonwealth of Massachusetts Official Use Only s Permit No. Department of Fire Services / Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C R 12.00 (PLEASE PRINT ININK O AL INFO ATION) Date: City or Town of: To the Inspector of Wzres: By this application the undersigne ives oti f his or her to tib o perform the electrical work described below. Location(Street&N er) Owner or Tenant '� Telephone No. 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 / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system 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 No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ O.o mergency ig ing rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No_.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No. of Alerting Devices Tons No.of Waste Disposers . HeatTotals: Self-Contained amp Number Tons KW Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Eg uivalent No.of WaterK� No.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.H y b No.of Devices or Equivalent 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 Electrical Work: F— (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under t&JpLins ndpenalties ofperjuty,that the information on this application is true and complete. FIRM NAME: LIC.NO.: 15 _1(' Licensee: John S. Bassett Signature LIC.NO.: 1533C (Ifapplicable, enter"exempt"in the license number line.) Bus.Tel.No.- 60- 594 59 8 Address: Alt.Tel.No.: j OWNER'S INSURANCE WAIVER: I am aware that the Lic 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 PERMIT FEE: S SignatureturaTelephone No. '� 1tM UU1VhVJUw rrr'J"n yr 1nr1aarit,nv0k8a i a �•�� -�- DEPARMUff OFPABI1 &4FM Permit No. =t / 11 C—^ BOARDOFFIREPREVCMONRIJGUTAT OMM70MI2,W tet" Occupancy&Fees Checked I, APPUCA71ONFOR PERMITTO P RMELECTRIC U WORK QPLEASE ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC SSTS ELECTRICAL CODE,527 CMR 12:00 PRINT IN INK OR TYPE ALL INFORMATION) Date ✓ l� ^�. Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical w rk desc ' d below. r- Location(Street&Number) Owner or Tenant Owner's Address Is this permit in conjunction with^a building permit: Yes No (Check Appropriate Box) 301 375 Purpose of Building / ' Utility Authorization No. Existing Service . Amps ,�/��oVolts OverheadED IZI Underground No.of Meters New Service 'Amps Volts Overhead =1 Underground ® No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 775. No.of Lighting Outlets No.of Hot Tubs No.of Transfomnrers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA zround El ground ri No.of Receptacle Outlets No.of 00 Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners 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 P'umps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryer Heating Devices KW Local Municipal Other Connections of Water Heaters KW No.of No.of Si Bailasis ydro Massage Tubs No.of Motors Total HP � C;M'age Ptasuantbd]etegmerB�ofMassadllst9sGaeellaWs Y �FbffqkEkftQxrpiW scommWor sl d9 a ut YES NO va6dptoafafsaneb11eOMM YES ffyauharedrdWYMple=irricalefhetypeofeo%eWby the {CJI BOND p amm p ftm**) B � 3' 09 —o va1>eofFJaalWodc$ aO DW - - s W� Pk>xllgesofpetjl><y. a �-- LimmNa r / l = Ur S I.io WNDq rC72IV Z BttsinessTd Na 91 J 9- 3- INSURANCE IxnawmdmtdieLi=wdDesmthateftkm =wya crilssubAarialq vah1asmg=dbyMawdltx mCkrleW Lam sig nvabm on ti's ptmrit app6wfial wanes this togttaarrrt eck one) Owner M Agent Telephone No. PERMIT FEE$ Signature 85MR—er"gent Seof a Date. TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SswCHU /7 This certifies that ........!-:........ . .............................. . ............................. 1. has permission to perform .............. C.?....... ...... ............IhIOPA� wiring in the building of .............................. ...... .... at........ (42 C4 .f9akl�...... ........ .North Andover,Mass. of 24 ................... Lic.N04N4a ............. -04 Fee.. -7 iiICALIJ SPECTO Check # 5765 JIM t.UtvttnUJV rrc fiu J n v,r lr x,czvaa.i�u w -- DE.PAiU31 VTOFPUDWSAFM Permit No. BOARDOFFMPREVRMONRDGUTAHONS527QNR12-M �o Occupancy&Fees Checked APPUCA77ON FOR PERMU T :descrnid RM ELEC MCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THELECTRICAL CODE,527 CMR 12:00 (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 workw. Location(Street&Number) ' Owner or Tenant Owner's Address Is this permit in conjunction with building permit: Yes No {.:J (Check Appropriate Box) Purpose of Building S/ ^�•f = Utility Authorization No. Existing Service 00 Amps 2ata'�GVolts Overhead Underground No.of Meters New Service Amps olts Overhead =3 Underground 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 KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets . ' No.of Gas Burners 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 ONHERY hmkyrarneCama-ag�Alts>arltbthetegiritanallsofMa�sad»se�LsGalaalLaws IheaamaltLiablhyhmaatct Fl,Gcyirr]tmdrlgCarlple� orffism6stsrl�ialaltrivalat YFS NO IhavesuhnimdvafidpmdofsmvodeOlf=YES ff3euhmdrdzdYFS,plea9 mdcatdeNrc)foweaWby chaddngdeINSURANCES BOND EstirrxMdValleofflectidWadc$ ,,1jJ3�� ao WbikbStart /3-09 kispectimDaieReglesbd Fz* ur'"lG--o f— FUW Slgnedundx' FtAnafptxjuty. a �- FMMNAME LiaenseNb / al2 L= uce�e l .IZG�:Ct,r'�ia�"�— sigt�rtae tioaLseNo ��U2�l day BusamessTel.Na S'7�l �� ,f-Z�L 0a y3 AL Mi Na tbW?,WSMAW4MWAMIamaw=dudcLxffwdmmthmftmummamWoritsatanWeWvWnasle4la 4rNbmduMCzlaallaws ardthatmysgna mcnd ispmtq*adamwaimesdislagznM (,lease check one) Owner a Agent a Telephone No. PERMIT FEE$ signature of Owner Of Agent '� ff Date.... 3 �J ... NORTq "� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING cwus� R This certifies that .... ..:° � �..(... .:/r. h.................................... has permission to perform .tz� .c... � �!? wiring in the building of.... .<'` -...................................I.......................... ...........�`................. .aECMICAL Noorthp�Andover,Mass. Fee.6�'°�... Lic.No.r .. f 17T............. �'/,....................... INSPECTOR Check # 4766 Office ffice Use only DEPARTN1ENNlOFPIIBlICS9FETY V Permit No. 7 BOARD OFFMEPREVEMONRl:GULA77ONS527CAM 12 VO � •� Occupancy&Fees Checked ` h I APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /D-3-,G 3 Town of North Andover To the Inspector of Wire: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) s wner r Tenant Owner's Address &flruC Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service AmpsVolts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 9/( v2 Cie d� moo'c� v�.vac�S No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA i round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones CZ 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 Other P Connections No.of Water Heaters KW No.of No.of Signs Bailasis MQ.Hydro Massage Tubs No.of Motors Total HP OTHER• LmsanoeCo Putst�ttothe ofMtsG�alLaws IhawaamaltIiabiLZtylr>s<uuloelb]icyinchx3ingCott>ple�& Cowrageoritssubsmntolequivalert YESED NO IhavegibyiledvalidpodofsametodrOfficaYES rT IfyouhaNedrkedYES,pleaseinhcaletheypeofeowrageby cheddrig the INSURANCES BOND r7 OIC M ( y) ExpitationD& Wolkrt /B'3-G3 EMmatedValueofEkdricalWO&$ toSta L�spet�orlDateRec)�cl Rough Final Signed underlie analties of petjtny. FIRMNAME Liaallo. Licer�ee `�e���r�s nr5e�.i Signauue LicffwNO n BusirmTel.No. y9.P--372 -S99S f PA— t54/em Ntl e3c-79 AhTe1 0� OWNI~1Z'S INSURANCEWAIVER,lam aware that the Lmm d oes not have the irtstlrA>re courage or its substantial etltuval alt as tegtu12c1 by Massadama s General laws °I and that my signattne ort[tris peamt application waives this regtmenlem (Please check one) Owner F-1 Agent Telephone No. PERMIT FEE Signature or Uwner or Agent u. a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 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 job. Company name: Address City Phone#. Y Insurance.Co. Policv#__ Company name: Address City Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1.500.00 and/or one years'imprisonmentas_welLas eivil.penaltiesjn.thelcxm-da-STOP V.1t M ORDER.and a.fine af_($]110.DD)atlay.againstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ,o 0 I do hereby certify under the pains and penalties of perjury that the information 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 Permit/Licensing. El Building Dept OCheck if immediate response is required Q Licensing Board p Selectman's Office Contact person: Phone A ❑ Health Department Other i 1763 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 9� Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. l Street or subdivision lot no. Mfr, f dry Owner Address Contractor ;AdPdre icant's Sign ure (717 3 z ?d C' 6-RV4T70AJ 2 i PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations I f BUILDING PERMIT NORrM Of,t�eo TOWN OF NORTH ANDOVER FO Gp APPLICATION FOR PLAN EXAMINATION Date Received �9A�gATED . Permit NO: �SSACHUS���� Date Issued: - !7 IMPORTANT:Applicant must complete all items on this page LOCATION Q � c s. v Pant PROPERTY OWNER L ©Cka <�f e i e Ona e 'Print MAP NO: PARCEL:. ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer ; DESCRIPTION OF WORK TO BE PREFORMED: 11's GLr l� Glc Identification Ptease Type or Print Clearly) s OWNER: Name: leo"G ,1WP Phone: Address: b OS ro A, CONTRACTOR Name: �o z < :Phone: �k}-- S —6 Y/ ! -e 12 fi ,Address: ' r'icr7 _ - Superv.isor"s Construction License: C-S e 9 3 Exp. Date: -Y-11 1 /10 p t 1 Exp. Date: ' Home�lm t-ovement:License: ! �/ ARCHITECT/ENGINEERPhone: N� I Address: Reg. No. FEE SCHEDULE:'BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ o �/ l ° !O OFEE: $ Check No.: �a3 Receipt No.: NOTE: Persons contracts g it ugistered contractors do not have acElheal,fund Signature of;Agent/Owri r Signature of contracti 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 ❑ 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 off from Fire Department prior to issuance of Bldg Permit Addition Or Decks I ❑ Building Permit Application ❑ Certified Surveyed.Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: 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 Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses j ❑ 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 i Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food.Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/Sii nature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE'DEPARTM'ENT TempFDumpster on site -yes °rao_ Located at 124'Main Street Fire'Department signature/date - COMMENTS Dimension Number of Stories: Total square feet of floor"area,"based on Exterior dimensions. Total land area, sq. ft.: 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.$100-$1000 fine NOTES and DATA— For department use I I ❑ Notified for pickup - Date c Doc.Building Permit Revised 2008 LocatioN��c i No. Date f � r °RTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ a„�,�,s��' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I 482 / Building Inspector Gas k me for Metroform CONTRACT A. The general project description is contained in the attached document and related documents from herein referred to as the "Proposal". B.The specific work to be performed by Contractor is the installation of the specified project as outlined in the Proposal. C.The total amount to be paid by the owner for the performance(subject to additions and deductions by written change order)shall not exceed the total specified in the Proposal. D. Progress payments will be made according to the payment schedule below. Materials will not be ordered until the materials deposit has been submitted.These times are subject to the timing of the construction and the lead times required for the ordered equipment to be delivered. E. Final Payment is due once work has been complete and approved buy customer. F.This Proposal expires 30 days following the date stated on the top of this agreement. No work will be scheduled without a deposit plus a signed copy of this agreement. All drawings and specifications contingent on agreement. G. If fob is of a retro-fitlremodel nature on an existing structure,and scope of work exceeds time estimated to complete because of unforeseen circumstances,owner agrees that he/she will be back-charged at a rate of$85 per man, per hour for all extra labor involved in completmg thejob. H. Contractor reserves the right to replace proposed models in the case of obsolescence, discontinuation or unavailability with a comparable model of equal or greater value upon written approval by customer. Contractor will not be held responsible or liable in any way for any said product's obsolescence,discontinuation or unavailability. Payment Schedule �� ��•�v 1 I. Contract Documents and Details The contract documents consist of this agreement, including all general provisions,special provisions, specifications,drawings, addenda,change orders, written interpretations,and written orders for minor changes in work.Work not covered by contract documents will not be required unless it is required by reasonable inference as being necessary to produce the intended result. The costs associated with any related work or materials,including,but not limited to electrical, drywall,paintmq, cabinets are not included unless specifically documented in the proposal. Contractor is not responsible for any underground trenching or laying or supplymg of conduit for outside wring. 2.Time With respect to schedule completion of the tasks in section D,time is of the essence. If Contractor is delayed at any time in the progress of the work by owner change orders, fire, labor disputes,acts of God or other causes beyond Contractor's control, the completion schedule for the work or affected parts of the work shall be extended by the same amount of the time caused by the delay. 3. Payments and Completion The above Payment Schedule is a guidelme and approximation. Payments may not be withheld under any circumstances. Final payment shall be due upon completion of project and approval and satisfaction of homeowner. Contractor is not waiving wriyhts to persue any and remedies at law or equity. Contracter will idmemfy and hold owner harmless. 4. Insurance Contractor shall purchase and maintain such insurance necessary to protect from claims under workers compensation and from any damage to the owners property resulting from the conduct of this contract. 5. Changes in the Contract The owner may order changes,additions, or modifications without invalidating the contract. Such changes most be in writing and signed by the owner. The contractor shall provide the owner in writing the amount of additional costs or cost reductions resulting from changes ordered within 10 working days unless this requirement is waived in writing by the owner. Change Orders shall be paid in full upon acceptance of change and shall not alter the contract's payment schedule. In case of product unavailability or discontinuation, contractor reserves the right to substitute equipment of equal or better quality with clients approval. Contractor will be held blameless in case of product unavailability or discontinuation. OWNER/A6 N L ,a�'►.�CS �a 6Lp bJLS COMP N �II CONTACT: 1 (�JKl.JtCc„ TITLE: DATE: DATE: J tAORTH 0"' ' o _ Andover Iia. ` LA ©. dover, Mass., O coC HIC ME WICK y�. Ao0ATED PQa\ `S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........1?A!1..j10 N�!!`e....................................................... ....................... Foundation has permission to erect.. ................ .................. buildings on .,04-r....40 ... ..� ...�........••....•.• Rough to be occupied as.... ...... ..... ................. , /. ''t#1 .�........................... Chimney C e provided that the person accepting this permit shall in every respect cont to the'terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final ' �YJ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR TARTS Rough ..................................................................... ............ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. 291/x+ 194 032" X 11\111�1, L KU? I\U2 —j i 6,32 OlMlio LAY ri) go 11 r! 80 8/15" P2 K4 K5 K! Key F1 7 7r,12 �K,3 06H L rio WASHER rc K14 30 25132" H - - - - - - - - - - - - - - - H5 --------- -------- K,,, ------- --- ------\� K 8 Fo Kirhe-We I Kia K7 Z-1 . i ma"I aA.ko A,l, P,5 O(CH --no WACHEI� KLO 2'-51/8" -2'-21/2" - 5'-513/1C 7-If 7/3" 2'-8 115" �O 7/32' V-6 114" 2`2 3/4" 3'-2 1/1' 1'-0 1/4" 251/8" 341/2"- 15 7/5" 321/5" HOWE KEOIENCE KITCHEN&PANTRY Date: 0/9/08 Prawlm� 0515 Revloed: Revised: Alhvc WoedwrkS 07m -Architectural C�ftllwork Revised: C)�,-Pen(Ark�t 03alm oVf oig7o AV% KU2 }f suazeRo 1 l 7 t j Ii II _ L�;. 632 OVERLAY P2 K-�� K4 �� K6 �✓ f - PLAN — ❑ 'i K6o P1 H6 H6 H6 H7 - H7 H7 I HOOD - =A - 1 37112" TA A g o 0 — -e RULL-our 5HELVE5 KU1 �" 5055/C4" KU2 r,Llo a 632 OVERLAY CUTLERY CUTLER e�oM - = a ET �AA `1 _ o C I 1L p o ❑ — 'ma ❑G — _ LK1. K - K3—K4 -0' J 2'-11" 118 4'-0' 1/Q,, 2'-53/8" f -__.__ 1 gyp"�- �- � `� ❑ �435/8" E L E VA T1 O N PULL-OUT SPICE KACK� A HOWE KE5IENCE/KITCHEN&PANTRY Date: 6/91_08 Drawing Number SCALE,1/2"=V-0` JJ��A ; kevleed: .�o11?E LV'p oodG lwrks CN7nC. Revised: H2 2rohimaaral C'llxwk Revleed: Cl��en C�JrkClt�r C��hclem CEfao ago Seale: 112"=1'-D ' { � i —r Kltchenaide Tr,Compactor e e e e 29 3/8" 29 /B" I O a4l Kltchenalde, . trash ?? L - - Compactor - PLAN PLAN B I SCALE: 1/2{l= 1-0fl SCALE: 1/2"= 1'-0" 6 6 yg y8 H8 519/32" 5 9/16" OPEN TO a 13 71/32"ENTRY 0 3 n [:IVC2 2-30' 77 8 11/16" I OPEN ro � KITCHEN = _ _ _ - i _- "ffee Maker& / SHA LOW I MIOFF .AK�1"::'�l � ���7oaeter StorageDOG F_AR 'T-775/16" 015 49/64"n Not In Use /..PAN KY i. p / LL/= � 51/2" 3-01, o _ 0 77/96" I —2'-0"—65/3Z--2- f/4"— 303/41-1 . 30 3/16"--�' 3'-0" �—2'-f0 3/32"–� 2'-0"—�1'-09/16'.1—3'_0" -5-211/16"�---,� ELEVATION ELEVATION E SCALE: 1/2"= 1'-0" HOWE KE5IENCE/KITCHEN&PANTRY Date: 6/9/08 Drawing065 05C20012 EM NO. N ANPOYEK MA Revised: Ce G6dN26Y✓�J Revised: n'.. A.-_/._._-....._t .o max._.__z Revised: HJ PU21 — — Asko CArr�ke Marvel K! ena I I P5 Washer _ Existing _ K7 KUJ' W6903Fi T79F1 Wlne Captain Compactor P�• ,� K9 K8 ---------______________________________ — — — — — — — — — — — — I I I/Ku4 PLAN C SCALE: 1/2" = i'-O" K7ollll Ku� IZI AAj5j,' H941 1\ gA I � i PU1 P02 .. ... o o ... ._. i _ I Asko sko Exlstn s Klt herald P6 WASHER o0 it Washer ryer Trash \ / W6903F1 7 93Ff 6 Campartor '�' \ / _ L ------------ OELEVATN IO SCALE: 1/2"= 1'-0" HOWE RESIENCE/KITCHEN&PANTRY Date. 6./9/08 DraWing Number 5 ? NO.A VOYEE,MA Revised; Revised: NOTE: - ISLAND MATERIAL TO 5E WOKMY CHESTNUT GfSH Puli aut 5TAINED TO MATCH h1 WA5HER K13 Trash COLOR SAMPLE. Iil_ h1�5 I I I KI 11 79" K1 I, I� 1ili) I I T�Iill� j h'9 - 15LANO PLAN PLAN D SCALE: 1/2" = 1'-0" 11 12 13 14 1110 H10 H11 H11 - 3INET LIGHT N013.0. �—A G)54 WA5HER o0 \ � Pu71 out I -�1-I LJ i Ll ' C E ISLAND ELEVATION 15LAN0 ELEVATION "I" -= SCALE. 1/2"= 1`-O" SCALE: 1/2" I --- --- R \ _ K14 —Half Noon Pull-Out ELEVATION D 15LAND ELEVATION SCALE: 1/2"= 1`-0" 15LAN0 ELEVATION I SCALE: 1/2"= 1'-0" SCALE: 1/2"= 1'-0" HOWE KESiENCE/KITCHEN&PANTKY Date: 6/9/G8 Dralving Number 665 O5GOOD RD. N0.ANC10VER,MA Revised: —Alpt 281? 6Pmdwa&(J7nC. Revised: N 413/96" 3� 413/16" I -- I I �I I �I i I 357/16" I 271/4"1 I 9 3/16" y—I 21/2"I� 21/2" I I 91,/2" ,May Vary / � � �May Vary i ; c I � s r r \ L 1f1 I 1 -I1 I I I I (V I I I m I — I � _—. 21' I, N I ii 11 N m 1i L i I tz - O - U 11 c,iR rxn�� 53/e„ I I IP3 P3A.GF � 413/16" 3 413/16" 3" 511/16" 413/1@ I 'I 16 13/16" �- 1711/16" 16 13/16" -, 17 N/iF � - I it 6 5/&" 1 I 6 5/3" IIS 3" 1 58 5/16" i 56 5/16" I ' _ I ' II 3,. 6518" I s z�8" a Tia„ 31/4" 31/4" 3 413/101, ,5 �3413/16" 0 0 o I o o 1211/16" 0 o 1711/16" 1613/16" 1613/16" 0 171i/16" In 1 13 16" v I i I OPENING 51ZE 271/2"X 1511/16" MiCPO WAVE 9 3/4'• 18 11!16" 20 Uc." I i O O O *--4 2 5/16" 89 7/16" COFFEE !� 15 3/4° I-OA3fER src. i ' Ia a i I a e o o 1314" 9 35164" 5112" 7.3/B" o a o 13T t,14" I o 0 0 o i i 9 3/16" 9,35/64" 77116" BREAD DRAWER LINtK o o e o 13/4" p o a i 7 7/16" ✓1 O 813/16" 2 7/5" 2'/8' 2 70' t —� �� 31/4" 4— � 1 i Y' 413/i6" 3.. 11/2 11%2" I ' I 271/4" 271/4" i 2112" 2112" 2112" — - 2 11/2" - �a 15 3/4" - S 3 Z m c 1 11/2" 91/2" �— O I 3, t\ Asko z a Dryer 26 3/8" 26 3/6" " 30 3/4" --_— T79 F1 7, 7' � s z . �3J �I Q 2 7/8" Z C ®Y P BEVELED GLA55 7/1@ 271/4" o ° I Y 2 1/2" 7— J k:i 13.4,7 J141/4"--- ' l HALF MOON PULL-OUT- i � E 3 Z c 11/4„ l,'12" 71/2" 57/6" P Y O ° c o C A I 20,3/5" I o ° 78 3/4' ` ti ®a U ... V 27 18" 2 7/8" W 12 23/5" 1"BEVELED GLA55 23/F A,113N CLAS SHE,''E5 V/I'li M f N'S 731/32" I I 27 v4" 1"BEVELED GLA55 I I 39 5/8., 1 21/2" -- 21/2" - 731/32" .141/4" —13 3/4" 731/32" KU11 2 3/5" 21/2" N � N 71/2" v m; - h N N 50,31-P _ 36" m 7" 15" �o N m 35 112' L... 1112" 71/2", 71/2" les 26 313" 30 3/4" TRASH PULL-OUT 2 1/11, m � m! ro 1 IE 24" 24!' K u l HOOP K U2 J-' 293/4" L. -I 671/4"---- i IO��II��I Ii K1 SII iii ''I� I���lii � � il���iii� Ali K4 � �I ��I��I '',/ �I�� � - K21 I �' IIS �� %' i;l 1332 GVEKLAY - - - - - - - - I� K311 ISI - - -- - K5 El l� - 6 �- �--471/2" 75/32" -61 V16" MOWS RESiENCE/KI7CHFN PLAIN — Date: Drawing N �65 055000 N A Revised: G� 71B 6d y>76Y �vc Revieed: HOLD CABINET BACK 1/4"FKOM COKNEK BEAD 6 -� 0.5. 24" ------ =-2015/16" 20 15/16" i 30 3/16" I 118 7B" 13/4" 13/4" �or 0 ' 125/8" 151/4"241/8' ----------------- 241/2"-------=--_f- -- 241/2" 125/8"— ----------- ------------------- a 7/16" - — — Keo o pT p Kitchenaide �—� 30 3/4" a 3/4^ Ma rVe i Trash Asko Asko 0 0- Compactor Existing Dryer Washer Wine Captain 703F? WOO 03F1 j �o o 29 3,18" —. F5 — 223/4" 271/2" i F U 2 15514, 15 3/4" 1 I U 1 I 231/4" � K9Q U � 291/4" I 2911/4K11 II K 92— I _ I I IIS full out K13 DISH Trash III III 111 243/4° Ii WR5HEK 1,33/4" 20 2,311 \ K14 I� I i 19" � � I 14 1/4"- `�,---i - � �'----311/2" ilI I j KU5 5 /3'� II K1 149 14�� I I I 22 3/16" K U4 HH 28° I I l I I 36 5/3" L 23 3/4"- 12"--- - - - - - - - - - - - - - - - - - - III III K8 �I K7 DISH �� ' K U3 � 5;/2" t I I �I III wa h� 2I I SHEK �I � III I i��'L/J0077/177.0fl2f Q�✓l�Lll4daG2t(�P� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration;, 148811 Explratigft -1.0/27/2009 Tr# 262860 Type .,n,1;idual GEORGE H.PIPEVIDIS° GEORGE PIPER61§ Ci�, 79 MICHIGAN AVE ,.` LYNN,MA 01902 Administrator F '• k Board of Building Regulations and Standards t Construction Supervisor License ar ° License: CS 89793 a ixi3i�ratlon 5/1132010 Tr# 24722 F1�-Itietign Ob' GEORGE H PIPERiDIS 85 EXCHANGE ST „ ✓ .�_ _y�J� l YNN ip1A 0190,1 Coiniiii`s'sioner METROFORM DESIGN CONSTRUCTION BOXFORD MA 01921 978-887-3235 OFFICE 978-246-6900 FAX Kitchen & Laundry Fover PROJECT: Howe DATE: ###I!# ADDRESS Osgood ESTIMATOR: ARCHITECT: PROD NO: CONSTRUCTION TRADE CSI $ VALUE JOBSITE REQUIREMENTS 850 BARRICADE/FENCING GENERAL LABOR& CLEANING/DUMPSTERS 5600 DEMOLITION 4600 SHORING 300 SITE WORK CONCRETE CONCRETE CUTTING MASONRY STRUCTURALSTEEL MISCELLANEOUS METALS 150 ORNAMENTAL METALS ROUGH CARPENTRY ' 4500 ARCHITECTURAL MILLWORK �p• WATERPROOFING EIFS/STUCCO FIREPROOFING ROOFING 1500 CAULKING 50 DOORS/FRAMES/FINISH HARDWARE 1500 SPECIAL DOORS STOREFRONT/ENTRANCES GLASS/GLAZING GYPSUM DRYWALL 5000 CERAMIC/QUARRY/STONE 10500 ACOUSTICAL CEILINGS FRP WOOD FLOORING 6800 CARPET/RESILIENT FLOORING PAINTING/WALL COVERING 3500 SIGNAGE CONSTRUCTION TRADE CSI $VALUE SPECIALTIES FF&E/ INSTALL OWNER ITEMS 350 FOOD SERVICE EQUIPMENT WINDOW TREATMENT ENTRANCE MATS ELEVATOR FIRE PROTECTION PLUMBING 5 fixtures 6500 HVAC ELECTRICAL 40 fixtures 7500 FIRE ALARM PRECONSTRUCTION SERVICES 0 GENERAL CONDITIONS PERMITS 1000 INSURANCE 1500 BUILDER'S RISK INSURANCE 800 OWNER'S PROTECTIVE LIABILITY INSURANCE 900 BONDS TAXES CONSTRUCTION MAI NAGER'S OVERHEAD 0 CONSTRUCTION MAI NAGER'S FEE 10 weeks 18800 TOTAL COST OF CONSTRUCTION $ 81900 OWNER LEGAL FEES ( loa OWNER LEASE FEES/DEPOSITS OWNER LOCAL REVIEW FEES FOR APPROVALS OWNER BUSINESS LICENSE OWNER LIQUOR LICENSE OWNER INSURANCE OWNER FINANCING COSTS OWNER UTILITY FEES/DEPOSITS OWNER A/E FEES OWNER MILLWORK PACKAGE OWNER FLOORING PACKAGE OWNER FF&E PACKAGE (TABLES, CHAIRS etc) OWNER INTERIOR DECOR OWNER FOOD SERVICE EQUIPMENT PACKAGE OWNER SMALL WARES PACKAGE OWNER LOW VOLTAGE ITEMS DESIGN/ENGINEERING CONTINGENCY CONSTRUCTION CONTINGENCY GRAND TOTAL $ Y , ` 4 R r � i 4 q t I r � ` i 'i..r'� � .`,1i . -ail_• r17.', ,. t 1 � d The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 t' i^ www.rnass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual):__ 4- Address: City/State/Zip: Z fjli'�_ n t.9,y Phone S 9 — 8 g y A,re�you an employer?Check the appropriate box: Type of project(required): 1.LJ I am a employer with a 4. ❑ I am a general contractor and 1 .6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7 Remodeling ship and have no employees These sub-contractors have 8. 9 Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their I O)Q Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L% repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Hunieowners who subtiiii this a„idavit indicating they are dviog all work and ihen hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 7/-&",_t Policy#or Self-ins. Lic. Expiration Date: p Job Site Address: (4c2& City/State/Zip: ,4, �J 4 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sic-,n ure: Date: / d 9 Phone#: ? 0"l - .S9 3- 3 Y k Y 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. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased 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 lana,or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4400 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26=05 www.mass.gov/dia TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAM DATION 0* µOt%ORTN o ,b;�tio 6 OL O A Permit NO: 4�v Date Received ^p�Y p�" i �- Date ISSUed: � SACH IMPORTANT:Applicant must complete all items—on this page LOCATION _ C� ,-GU4 3 > / Pr t PROPERTY OWNER ®Cs6(I S� Print MAP NO.' PARCEL: ZONING DISTRICT: I i TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential G New Building One family CtAddition F Two or more family u Industrial i F0<1teration No. of units: Repair, replacement Assessory Bldg Commercial Demolition i Moving(relocation) ❑Other Others: r Foundation only DE , RIPTION F WORK TO BE PREFORMED le-e IleL 14U� 41tee, UlI()D D I Wa 'AJ`bow� Identifica ion Please 7C. rint Clearly) ' OWNER: Name: PaL,-6114L✓ Phone: f N L16 }' Address: (n(� G G P S I CONTRACTOR Name: l tl� I�,e i ,v � A71 �i� Phone: ���s-�0�-i 3 7 y Address: ov Ai Supervisor's Construction License: o67IN O Exp. Date:' Home Improvement License: 1�J�J Exp. Date: y7 ARCHITECT/ENGINEER �21 {1 Z' Name: Phone: .-address: � "V N'^JLk �( to".n()1 D Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER S.F. Total Project Cost :$ - FEE:$ - C) � 7- -Check No.:_ ,� Receipt No.: Page lufd 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 ❑ 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (if Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ 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 In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Due:INS PECTION.>LSE.RVICES 1)EP%R'I'NIFNI':BPFORAlo5 Pnnr d nl'I Ii f I TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools Public Sewer _ Well Tobacco Sales U Food Packaging/Sales ❑ �_� Permanent Dumpster on Site u Private(septic tank,etc. EllElectric Meter location to project NOTE: Persons contracs do not have access to the guaran •fund Signature of Agent/Owner= Signature of contractor , Plans Submitted ❑ fied Plot Plan ❑ Stamped Plans LY THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATIO 0-6& b, COMMENTS O —w�� Gj �`' 1�� meck itnKK. DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connectioniSignature& Date Driveway Permit Temp Dumpster on site yes_no_ Fire Department signature/date — Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Re uired Provides Re aired Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) to Page 3 I1I'.1 Doc:INSPFC'rIONAL SFRVICES UEPAR'I'MENT 131IFORM05 ('-med AIC'.Jan 2006 Location I ti 0/ -12al C Date No. TOWN OF NORTH ANDOVER ' ` Certificate of Occupancy $ ♦i � i. �ssACHUS � Building/Frame Permit Fee $ i" Foundation Permit Fee $ S E' Other Permit Fee $ �- TOTAL $ Check # I 19659 All k Building Inspector & NORTH Town of _� M .19 over Or��..✓.R+��vv. ���t4 No. Zov Z zo E dover, Mass., A �_ COCHICMEWICK �` ��ADRATED PPa` BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............P.%.......*0.410#. ................................................................. ... Foundation has permission to erect........................................ buildings on..`O.5 --le.................. Rough 3 to be occupied as.... .'f s!.I�Is Chimney .................. . ....... .. ........ .............................................................. provided that the arson acce in thi ermd shall m eve respe� or the terms of the application on file in P P his office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EMPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARVAt Rough ................ ..... ... Service .. .. . ... ............. L ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. NORTH Town of over No. -v7l k7 0 dover, Mass. Y ICA 204 AERATED Ple C2 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THATIt BUILDING INSPECTOR ..............Ps........41W . ....... ....................................................... .r.................. ..................... Foundation has permission to erect........................................ buildings on-C-14-Ir Rough tobe occupied as............... .!.t4r. ...... . .............................................................. Chimney -idperm shall a r Aforwi6 provided that the person a�iijfit� spa the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC�-TR1055TARTes ELECTRICAL INSPECTOR Rough ........ Service .................. Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 5• www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information t Please Print Le ibl Name(Business/Organization/Individual): 1f, ID'U Address: �� >V�l City/State/Zip: X���Lt� ly Phone#: ')-Iq — f7 13 7 L/ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. [:1 We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonnation. 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 subcontractors and their workers'comp.policy infonnation. I am an employer that is providing workers'compensation insurance for my yenployees. Below is the policy and job site information. e--; Insurance Company Name: i / ( ,p Policy#or Self-ins.Lie.#: --77 Expiration Date: by" Job Site Address: C�Sy���a City/State/Zip: 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for surance coverage verification. I do hereby certify nd r t e p ins and penalties of perjury that the information provided ab a is rue and correct Signa re: Date: 19 Phone#: �U ✓ 1�� TIC6 T� -72,% 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 I 6.Other I Contact Person: Phone#: I i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased 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 pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia I DATE(MM/DD/YYYY) PRODUCER Ar-ORD. CERTIFICATE OF LIABILITY INSURANCE 9/26/2006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Yarjan Ins Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 271 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Stoneham, MA 02180 (781) 438-5577 INSURERS AFFORDING COVERAGE NAIC# INSURED MetroForm LLC INSURER A: CONEXCO / PENN AMERICA INS COS INSURER B: AIG / GRANITE STATE INS 60 - 216 Ipswich Road INSURER C: Boxford, MA 01921 INSURER D: 978-500-1374 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXP IRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000 ,000 X COMMERCIAL GENERAL LIABILITY PREMISES R NTEUoccurence $ CLAIMS MADE OCCUR MED EXP(Any one person) $ A NEW ISSUE / TBA 9/25/06 9/25/07 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ X POLICY PRO LOC JECT 1-1 I AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS _-- � BODILY INJURY NON-OWNEDAUTOS (Peraccident) $ PROPERTY DAMAGE $ (Peraccident) I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN FAACC $ AUTOONLY: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR C CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ i WORKERS COMPENSATION AND 7DISEASE - OTH- ' EMPLOYERS'LIABILITY S ERANY PROPRIETOR/PARTNER/EXECUTIVE6ZZUB-0862057-7 9/15/06 9/15/07 ENT $ 100,000B OFFICIfyes, Rscribe R EXCLUDED? A EMPLOYE $ 500,00QIfyes,describeuntlerSPECIAL PROVISIONS belowOLICY LIMIT $ 100,000 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL North Andover, Massachusetts IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD25(2001/08) ©ACORD CORPORATION 1988 V - lhQ '(2r�Inilnnm/aan//h, ati,,f'If,'a:r_:r- Board of Building Regulations and standards - HOME IMPROVEMENT CONTRACTOR Registration;: 145596 Exp`iraBon: 2114/2007 Type:: DBA METROFORM DESIGN/CONST CHARLES APOSTOLOPOULOS 216 IPSWICH RD cG �• szla' BOXFORD,MA 01921 Administrator t._4cen r.m rjt>I tra9an valld for ird"(1111 u..' A,;, U ore the expiration date. If iuunCt re:°.'n ;> Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Nf-t valid without signature .3 .:.r..::.;•:r::..: rr.•'• ` BOARD OSTRUCOiNN 5UPERV SORB �ren*ae: CD '� IUfOR/1rJb�+ tilAl+tlnte:' in no: KASfi ft pipltes: tOrOar'tOGb Re9lrietotf• 00 r r•utit�,TC)5 N 4TAy1NI75 rr'ft,e:Pi1J - -. -1�fiR�rsU�trei.B - T �b13d E61bSTLZTZ 7.q:( i ;^. ..� Permit# Permit Date REScheck Software Version 3.7 Release 1 Compliance Certificate Project Title: Addition &Alterations Report Date:09/26/06 Energy Code: 1995 MEC Location: Peabody,Massachusetts Construction Type: Single Family Glazing Area Percentage: 66% Heating Degree Days: 6268 Construction Site: Owner/Agent: Designer/Contractor: 665 Osgood Street Douglas Howe Phillip Kritikos Andover,MA 01810 665 Osgood Street Kritikos Associates Architects Andover,MA 01810 7 Winter Street Peabody,MA 01960 978-531-4164 p.krit@verizon.net Ceiling 1:Cathedral Ceiling(no attic): 72 30.0 30.0 1 Wall 1:Wood Frame,16"o.c_: 100 13.0 13.0 2 Window 1:Wood Frame:Double Pane with Low-E: 66 0.280 18 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space: 57 30.0 30.0 1 Crawl 1:Solid Concrete or Masonry: 65 5.0 5.0 7 Furnace 1:Forced Hot Air:98 AFUE Compliance Statement:Statement of Compliance:The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 1995 MEC requirements in REScheck Version 3.7 Release 1 and to comply with the mandatory requirements listed in the RESc k 117yeaon Checklist. 'G�2. ui der/Designer Company Name Date Addition&Alterations Page 1 of 4 Circulating Hot Water Systems: ❑ Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: ❑ All heated swimming pools must have an on/off heater switch and require a cover unless over 20%of the heating energy is from non-depletable sources.Pool pumps require a time clock. Heating and Cooling Piping Insulation: ❑ HVAC piping conveying fluids above 120 degrees F or chilled fluids below 55 degrees F must be insulated to the levels in Table 2. Addition&Alterations Page 3 of 4 Table 1:Minimum Insulation Thickness for Circulating Hot Water Pipes Insulation Thickness in Inches by Pipe Sizes Non-Circulating Runouts Circulating Mains and Runouts Heated Water Temperature(°F) Up to 1" Up to 1.25' 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2.Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range("F) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD:(Building Department Use Only) Addition&Alterations Page 4 of 4 �(jREScheck Software Version 3.7 Release 1 Inspection Checklist Date:09/26/06 Ceilings: ❑ Ceiling 1:Cathedral Ceiling(no attic),R-30.0 cavity+R-30.0 continuous insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-13.0 cavity+R-13.0 continuous insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with Low-E,U-factor:0.280 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?_Yes_No Comments: Floors: ❑ Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-30.0 cavity+R-30.0 continuous insulation Comments: Crawl Space Walls: ❑ Crawl 1:Solid Concrete or Masonry,4.0'ht/3.0'bg/3.0'insul,R-5.0 cavity+R-5.0 continuous insulation Comments: Air Leakage: ❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. ❑ Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly with a 0.5"clearance from combustible materials.If non-IC rated,the fixture must be installed with a 3"clearance from insulation. Vapor Retarder: ❑ Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: ❑ Materials and equipment must be identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. ❑ Insulation R-values,glazing U-factors,and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: ❑ Ducts in unconditioned spaces must be insulated to R-5.Ducts outside the building must be insulated to R-6.5- Duct Construction: ❑ All ducts must be sealed with mastic and fibrous backing tape.Pressure-sensitive tape may be used for fibrous ducts.Duct tape is not permitted. ❑ The HVAC system must provide a means for balancing air and water systems. Temperature Controls: ❑ Thermostats are required for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Addition&Alterations Page 2 of 4 mds6performance Marvin windows & Doors, MDS version 16.2, Build 1070, 9/25/2006 MDS RB Tabs version 16.2 Build 874 MDs RB code version 16.2 Build 997 Product Performance Report Page 1 --------------------------------------------------------- Unit Name: 04 Call Number: WAWNP-CUSTOM R.O. : 73" x 17 1/2" Glazing: 1" Insulating Low E II Argon - clear --------------------------------------------------------- Air Infiltration N/A CFM/ft2 Daylight Opening 4. 5 Sq Ft ventilation 0 Sq Ft Energy Efficiency 0.28 U value 3.57 R value Egress Net clear opening 0 Sq Ft width 0 In Height 0 In Sound Transmission 37 STC window Grade 40 NWDA STC values are for glass values only o Page 1 mds5performance Marvin windows & Doors, MDS version 16.2, Build 1070, 9/25/2006 MDS RB Tabs version 16.2 Build 874 MDS RB Code version 16.2 Build 997 Product Performance Report Page 1 --------------------------------------------------------- unit Name: 02 Call Number: wCMP7260 R.O. : 73" x 60 9/16" Glazing: 1" Insulating IoW E II Argon - Clear --------------------------------------------------------- Air Infiltration N/A CFM/ft2 Daylight Opening 24.39 Sq Ft ventilation 0 Sq Ft Energy Efficiency 0.28 U value 3.57 R value Egress Net Clear Opening 0 Sq Ft width 0 In Height 0 In sound Transmission 37 STC window Grade 50 NWDA STC values are for glass values only 0 Page 1 mds2performance Marvin windows & Doors, MDS version 16.2, Build 1070, 9/25/2006 MDs RB Tabs version 16.2 Build 874 MDS RB Code version 16.2 Build 997 Product Performance Report Page 1 --------------------------------------------------------- unit Name: 01 Call Number: wCMP4860 R.O. : 49" x 60 9/16" Glazing: 1" Insulating LOW E II Argon - Clear --------------------------------------------------------- Air Infiltration N/A CFM/ft2 Daylight Opening 15.59 Sq Ft ventilation 0 Sq Ft Energy Efficiency 0.28 u value 3.57 R value Egress Net Clear opening 0 Sq Ft width 0 In Height 0 In sound Transmission 37 STC window Grade 50 NWDA STC values are for glass values only o Page 1 mds4performance Marvin windows & Doors, MDS version 16.2, Build 1070, 9/25/2006 MDs RB Tabs version 16.2 Build 874 MDS RB Code version 16.2 Build 997 Product Performance Report Page 1 --------------------------------------------------------- Unit Name: 03 Call Number: WAWN-CUSTOM R.O. : 49" X 17 1/2" Glazing: 3/4" Insulating Low E II Argon - Clear --------------------------------------------------------- Air infiltration N/A CFM/ft2 Daylight Opening 2.88 Sq Ft ventilation 3.55 Sq Ft Energy Efficiency 0.3 u value 3.33 R value Egress Net Clear opening 0 Sq Ft width 0 In Height 0 In sound Transmission 32 STC window Grade 40 NWDA STC values are for glass values only D Page 1 ESRI ArcExplorer 2.0 Map 35 Parcel 26 665 Osgood core_naparcels core_nawatersheddistrict z � core_nahistoricdistrict s core nazoning (ZONECODE) 210B 1 210B2 210B3 210B4 210GB k 21011 21012 s g airy, , 21013 2101S y s, 210PCD 210R1 210R2 a 210R3 210R4 210R5 � s 210 R6 210VC �w 210VR N Tuesday, Oct 3 2006 Interior: Blue board and plaster for entire new space; l 500.00. Trim around windows and baseboard to match existing home decor. 1500.00 Hard wood floor prep: underlayment will be installed in order for hardwood finish floor to be installed ( hardwood floor Not inc)uded) will install temporary cork tile. (Tile to be purchased buy client) 1200,00 Electn"In interior of kitchen, nook to be wired for 4 receptacles and 2 hcjhts ( I light can be a chandelier outlet, other can be wired for another type of lrght.(chandel;er not included) An allowance of 1350.00 has been allotted for all work. Lighting fixture will be picked buy chert. Flumbing: a 600.00 allowance for outdoor plumbiny do be relocated in order for . new foundation to be installed. HVAC: well be relocated into new kitchen nook. Construction Debns: a srrall 15 yard dumpster will be. onsite and filled with all debris from project once project is complete, Metroform will have dumpster removed, Matenals and labor----------- -- -------------------- i Douegla5 Howe Jr. September 19, 2000 GG5 05g0041 5t. North Andover Ma. Metroform Design/ Con5truction proposes to provide 6e56gn build 5erAce5 to Construct r.itchen nook Description of work: General Conditions: Site management, project cleanup. l .5 months. Metroform is a fully insure,6r company providmcg Workman's comp AND Liablgty insurance. Metroform supervi5or will be on project for claily site visit and progress reports. North Andover Permits: before construction All necessary permits with North Andover building department in order to be able to erect main structure, t'ytchen Kook: size is 4; x 8-51/2 x 12 —u 518 + or - Architect:. metroform will provide a registered architect to c jenerate an elevation, floor plan, foundation, framing plan. Plans will be ready for permitting once approved. $2000.7.00 Excavation: foundation excavation will be done buy use of- a small tractor to remove debris. $1800.00 Foundation: .A footing will be poured once excavation is complete, foundation wall height will be determined once architectural are complete. A foundation wall will be poured on to footing butting up to exe5tincj home. Foundation ----------------------------------------------------$ 2900.00 bm : a concrete floor --------------------------------------------------------$900.00 fMCLut3�s1 Frame: floor will be con5trucred of Prc55ure treated twill and jo!5t.. 314 plywood glued and screwed, "VVA will consist of •2x4 KD, exterior grade = Metroform CONTRACT A.The general project description is contained in the attached document and related documents from herein referred to as the "Proposal". B.The specifc work to be performed by Contractor is the installation of the specified project as outlined in the Proposal. C.The total amount to be paid by the owner fo the performance(subject to additions and deductions by written change order)shall not exceed the total specified m the Proposa; D. Progress payments will be made according to the payment schedule below. Materials will not be ordered until the materials deposit has been submitted.These times are subject to the timing of the construction and the tead times required for the ordered equipment to be delivered. Payment is due once work has beer,complete and approved buy customer. P.This Proposal expires 30 days followtng the date stated on the top of this agreement, No work will be scheduled withovt a deposit plus a stemed copy of this agreement. All drawings and specifications cont!ngent on agreement. G. If job is of a retro-fitlremodef nature on an existing structure,and scope of work,exceeds tune estimated to complete because of unforeseen circumstances,owner agrees that heJshe will be back charged at a rate of$65 per man, per hour for all extra.labor involved in completing the job-. H.Contractor reserves the right to replace proposed models in the case of obsolescence, disconttnuation or unavailability with a comparable model of cquai or greater value,upon written approval by customer. Contractor will not be held responsible or liable in any way for any said product's o bsolescence,discontinuation or unavailability. co J A'e�..` �` �/ eZ[� c �'.�j�r� ne_ �t .',��C�+ �Q�n."�`_rG,r✓c �JL� Payment 5checiule �e .1i--u.Ger 4,— ���r � ���•civ �; J I.Contract Documents and Details The contract documents consist of this agreement, including all general F,rovrsorin, specal provis,ons, spec.fications, drawings, addenda-change order,,, written interpretations,and wri ten orders`or mrror changes in work, Work not ea.,cred key contract documents will not be re^qu!red uriless it is recyuired by reasonable inference as being necessary to produce the intended result,rhe costs associated with any realated work or ma{erials,in ciudine3,butt not limited to electrical,drywall,paintmaj,cabinets are not included unle55 specifically documented in the proposal. Contractor is not responsibly for any underaround t;ren,hm:; or laying or sunpiymg of conduit for outside wiring. 2.Time With respect.to schedule:cornpletion of the tasks in i�ec•`_;on D,tame;s of the essence. If Contractor;s d<slayed at any time in the progress of ^e work by owner change orders. tire, labor dmpures.acts of God or other causes beyond Contractor's control, the compietron seheduic for the wcrk or affected parts of the'work shall be extended by the same amount of the tine caused by the delay. 3.Payments and Completion The above Payment 5cr;edulP is a 3ui6cfne and approximation. Payments may not be w;thheld under any orcurnstance5. Final payment shall be due upon completion of protect,and approva;and satisfaction of homeowner. Contractor;s not waiving wrr,3hts to f-ersve any and remedies at law o-e misty.Contracter will idmenrfy and hold owner harmless. 4 Insurance Contractor shall purchaeie a:id mamtain such ircvranre necessary to protect frorn clarmg under workers comm,,-nsation and from any damage to the owners property re5uiting from the coriduct of this contract. 5. Changes+n the Contract The owner may order chap jes,additions, o,'modrficatrons withour. nvalidatiny the contract. 'uch:harines must be in writmt and . signed by the owner. The contractor shall provide the owner;n wr;`.:,ry the.amaunt cif additonal costs or cast reductions reauitrng from changes ordered within 10 workang days unless this requ;rearnent;s waived;n wntiny by tiro owner. Charge Orders shall be pard in f0i upon acceptance of change and shall not alter the contract';payment scnedule. in case of product srnavailabdrty or drscont,;nuatior, contractor reserves the right fes.+substitut,m equipment of equaf or better quality with clients approval. Contractor will be held blameless;n case of product unavailability or crrcont;nuaton. / f OWNER/ EN ' COMPA Y: CONTACT: TITLE: DATE: e l -DATE: ----------- I DEED REFERENCE: BOOK 5142 PG 336 PLAN REFERENCE: PLAN #13275 MIDDLESEX NORTH DISTRICT REGISTRY OF DEEDS S1¢'29'23~ 43 55, E EXIST / — D.H. �\D.H. S13,26 SHED . 18g•6j EXIS37'52 9 E S14 ' 1 `397, 9.82, 50.0'.ROP D.H. } e� X_ U ]1^ I E XSTING � </N �~ � 1133p Osie `�\D.H. S73-48,41,,E w ' X66 PROP I �A�K CINE 166.05' S01 0 15 6'x8' I �, 15641sT ocoFk/SANG ADDITION i D.H. 115 ID.H. zRF SCENIC ui T K� EASEMENT ro LOT 1co Y153380 S.F. (C I o)Q 3.52 Ac. ca C.B.A. = 100% N26'15'02"W N �/ cn 1 448.17' SCENIC S16',36 MII EASEMENT EASCENIC SEMENT SCENIC EASEMENT ui 42,7to 0 1- 5' n. I — —— — — — — — — — c'i o� EXIST GARAGE z ¢5¢5 D.H. o I LOT 2 LOT 3 LOT 4 N 16.3_05„w '1 N r� co rn I 19 (JT7L/7y W � N Cp Z 88 16' EASEMENT / OSGO00 L=ss �¢ _. R=406.04 ' STREET t� ZONING; DISTRICT- R-2 l�ti0 SURv�°� MINIMUM SETBACKS- EXISTING SETBACKS- PROPOSED ADDITION SETBACKS- FRONT- 30' FRONT- 396' FRONT- 445' SIDE- 30' SIDE- 85.1' SIDE- 136' REAR- 30' REAR- 39.7' REAR- 50.0' PROPOSED SITE PLAN ASSESSORS MAP 35 BLOCK 26 LOT 0 MARCHIONDA AND ASSOC.,L.P. X665 OSGOOD STREET ENGINEERING AND PLANNING CONSULTANTS NORTH ANDOVER, MA 62 PREPARED FOR ON A , AVE. SUITE I DOUG AND JANICE HOWE STONEHAMMA. 02180 665 OSGOOD STREET (781) 438-6121 NORTH ANDOVER, MA SCALE:1°=100' DATE: 10/5/06 DEED REFERENCE: BOOK 5142 PG 336 PLAN REFERENCE: PLAN #13275 MIDDLESEX NORTH DISTRICT REGISTRY OF DEEDS S 1 43 553E EXIST D.H �\D.H. s1 \_ SHED .i 3, / EXIS 18s 67 ,6'5,9 E s. 514'3 5�2'E I� X39.7' 82, I —6 op ROP D.H. } 85.1. �FkiS \ \X`UT 1139.50 E �\ D.H. I EXISTING <4Nc� `-°sere �' s1348,41"e tW PROP I `A�K CINE 166.05, SO7 44 0 6X8 I S6 "5 oFk/SANG ADDITION i D.H. D.H. SCENIC ZI 4q4 I EASEMENT a m °� LOT 1 I fO I 153380 S.F. 't Q 3.52 Ac. I 'O C.B.A. = 100 N26'15'02"W N 1 N 448.17' SCENIC W16'�� �i EASEMENT SCENIC SCENIC EASEMENT EASEMENT 5,1 n. — — — —— —— — — M�oo EXIST GARAGE z I N1s31=5 \ .ID.H. N M I LOT 2 LOT 3 LOT 4 M � I P N I 'O , N I N p) N I c0 I Z ` I \ 68.16' — EASEMENT l I OgOOOO x=89 74' R-406'04' STREET Noy► ZONING DISTRICT R-2 MINIMUM SETBACKS- EXISTING SETBACKS- PROPOSED ADDITION SETBACKS- FRONT- 30' FRONT- 396' FRONT- 445' SIDE- 30' SIDE- 85.1' SIDE- 136' REAR- 30' REAR- 39.7' REAR- 50.0' PROPOSED SITE PLAN ASSESSORS MAP 35 BLOCK 26 LOT 0 MARCHIONDA AND ASSOC.,L.P. *665 OSGOOD STREET ENGINEERING AND PLANNING CONSULTANTS NORTH ANDOVER, MA PREPARED FOR 62 MONTVALE AVE. SUITE I DOUG AND JANICE HOWE STONEMA. 02180 (7811)) 438-6121 665 OSGOOD STREET SCALE:1"=100' NORTH ANDOVER, MA DATE: 10/5/06 DFFD REFER=NCE: BOOK 5142 PC 336 PLAN REFERENCE: PLAN #13275 MIDDLESEX NORTH DISTRICT REGISTRY OF DEEDS S1 3 55 43E EXIST O.H.• D.H. SHED \ •- S13'2 / EXIS I 789 6j E S".' s?d `3917' f \9.82. J 7'—50.0'PROP D.H. ..\ s13.4j- _ 11" 1 85.1. oF�/Sn ��\`CUT I ]39.Sp• E D.H. EXISTING <c N� �° s?8 \� s1348'�� E PROP I �q�K 11NE 166.05' Spl�4 o - 8'X 8' I - \ s6 4S' o � Fkc ADDITION i D.H. Z n J RFT SCENIC Z J P,. � EASEMENT 00 LOT 1 I `° v J 153380 S.F. m Q 3.52 Ac. CD C.B.A. = 100% N126'15'02°W / w 1 -1148.17' SCENIC EASEMENT SCENIC SCENIC J 0,36'25,"E �J EASEMIENT EASEMENT JI \I- - I I — — — — O o EXIST GARAGE N16'345.45• D.H. N o LOT 2 LOT 3 LOT 4 CN C6 O N LD � I n I N � N II Z� I 2S 4j•'w� � 0,3(30c)z)i6 s, 406°4- STREET It ZONING DISTRICT- R-2 �N� U V MINIMUM SETBACKS- EXISTING SETBACKS- PROPOSED ADD[ ION SETBACKS- FRONT- 30' FRONT- 396' FRONT- 445' SIDE, 30' SIDE- 35.1' SIDE- 136' REAR- 30' REAR- 39.7' REAR- 50.0' PROPOSED SITE PLAN ASSESSORS MAP 35 BLOCK 26 LOT 0 MARCHIONDA AND ASSOC.,L.P. X665 OSGOOD STREET ENGINEERING AND PLANNING CONSULTANTS NORTH ANDOVER, MA PREPARED FOR 62 MONNALE Ate. SUITE I NEHADOUG AND JANICE HO — STO(761) 4 MA. 02180 W= 665 OSGOOD STREET (78i) 438-6121 NORTH ANDOVER, MA SCALE:1"=100' DATE: 10/5/06