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Miscellaneous - 72 RUSSELL STREET 4/30/2018
N OO o � C: Co Com m m m Date�j ..................... NORTH TOWN OF NORTH ANDOVER PERMFOR GAS INSTALLATION PE- ... so.rc'/ This certifies that.. re�- Wf ................................................. ' A has permission for gas installation ...... ......................................... ................... i ...................................... in the buildings of .... . )'� North Andover, Mass. .............................. at .................................................................... ..... ... Fee a.0 ..... Lic. No. GAS INSPECTOR Check # 9126 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - - I CITY--K� ka...ANDOOEA.._.... __.__.. __.. MA DATE ��,�-�-� - � PERMIT# JOBSITE ADDRESS ,� ei Sl...__.._.._._:__ __-- OWNER'S NAME GOWNER . .E..._... • ADDRESS Io _. ... _ TEL g 47-.713 AX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONALF71 RESIDENTIAL CLEARLY NEW: Q RENOVATION: El REPLACEMENT: ' PLANS SUBMITTED: YES E] NO APPLIANCES 7 FLOORS— BSM 1 1 2 3 4 5 6 7 1 8 1 9 10 _11-12 13 1 14 BOILER -- - - -- - ! -.. f _._ •.—. E-7-71 -- BOOSTER CONVERSION BURNER f--� -fir--� COOK STOVE I. . DIRECT VENT HEATER RYER DIREPL FIREPLACE FRYOLATOR FURNACE _ . I .. i _..._ . ! .. I I I—All GENERATOR GRILLE INFRARED HEATER �- _ . LABORATORY COCKS MAKEUP AIR UNIT ...... ... _-........_..._ OVEN........ _.-.. 7771 POOL HEATER ROOM [SPACE HEATER ROOF TOP UNIT _ .. _ ._....�i ..._ .. TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER_.. - -- - - - - ._ ...._ . I._.._._. _ 1--------- ou e GA s, 114.1c _9t fie-- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES &NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ( OTHER TYPE INDEMNITY Q BOND [71 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Ej AGENT Lj SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc with al Pertine o i of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. zi PLUMBER-GASFITTER NAME y4_N, 8: j LICENSE # 15Ry SIGNATURE MP 2'MGF F-71 JP 0 JGF 0 LPGI CORPORATION 2# }PARTNERSHIP E]# LLC -_ # j COMPANY NAME: _ -Sf ADDRESS CITY BNSCftt'1N TASTATEq ZIP p� TEL /?--ZP7 _ - - - FAXI.. CELL 5b8-%ab EMAIL w F• O z z 0 H U W a z a Pro � a Z❑ z �- P.4 � F � W o o W IL # W LLJ �- W zCl) ~ N W w O W w N a z a a a � v J IL Q / = w I-- U- cc O z z 0 H U w a cc Q t� v 0 x FEENBRO-01 CLEDDUKE ACORO� CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 2//25/22512014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such enddrsement(s). PRODUCER Rogers & Gray Insurance Agency, Inc. 434 Rte 134 South Dennis, MA 02660 CONTACT NAME: April Skala PHONE FAX A/c No Ext): A/c No): (877) 816-2156 E-MAIL ESS: askala@rogersgray.com INSURER(S) AFFORDING COVERAGE NAIC # 02/01/2014 INSURERA:OId Republic General Insurance Corp. EACH OCCURRENCE $ 1,000,00 INSURED INSURER B Feeney Brothers Services LLC 103 Clayton St PO Box 220801 INSURER C: INSURER D: INSURER E: Dorchester, MA 02122 INSURER F: COVERAGES CERTIFICATE NUMBER: RFVISInM MI]MRFP- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE ItlSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFF MM/DD/YEXP YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR A2CG07501400 02/01/2014 02/01/2015 EACH OCCURRENCE $ 1,000,00 DAMAGES TO RENTE occurrence $ 1,000,00 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COM P/OPAGG $ 2,000,00 EBL AGGREGATE $ 2,000,00 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY OPERT DAMAGE $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ ' DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY PROPRIETOR/PARTNER/EXECUTIVEY OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A2CW07501400 02/01/2014 02/01/2015 VJC STATU- OTH- XT ORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD PLUMBE'RS``AN`D GAS:E;In;ERS`<< I SSUES».THEFOLLOWING "`L IACENSE`> R gi.-STERE D AS:r>A <>RIL MB LNG CORPS .Y 7 "'DAVIID' W GARFIELD `FEENEY::BR:OHERS SERVICE;,s<;tLLC't`Is, �Z' Z 1 WILLOW:>:.:.ST ;�. :;;<; ':.. \ _ h BR'O KTON»»: v "AA •02301 ` 21 . . COMMONWEALTH OF MASSACHUSETTS- PLUMBLPS AND GASFITTEI?S LICENSED CS A IAASTER PLUMBER ISSUES THE ABOVE LICENSE Td: DAVID W. GARFIELD ' -21 WILLOW $T BROCKTON MA 023.01==145 15645 L5/01/14 1665LICENSE 8 • EXPIRATION DATE SERIAL N COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASfllTch2 LICENSED AS A JOURNEYI9AN PLU BER ISSUES THE ABOVE LICENSE TO: DAVID W. GARFIELD I� 21 -WILLOW ST �3 ^: BROCKTON + MA 02301-1*45.1 23645 05/01/14 1615'34LICENSE I • EXPIRATION DATE SERIAL NO. PLUMBERS'"'AND GAS:Esa TTERS''> ISSUE&JI-IE FOLLOWING `L IAC fltki ;:.. RSG"I.S7ERED AS{;R:<<:P°4UMB LNG CORP DAVIAD. W GARF.I ELD ; -! f FEENEY %B LO SERVI-G.1^;,,;;LLC'�� /* 21 W I L COW'.:ST ><, c y BftflCKTON:;.: AA:O 2301 R :>1494goo igmal � t COMMONWEALTH f PL"UMBLPS AND GASFITTERS LICENSED O•S A 1AASTER PLUM -BER c ISSUES THE ABOVE LICENSE TO: DAVID W GARFIELD R 21 WILLOW 51 BROCKTON MA 023.01'=1451 15645 L5/01/119 166583 LICENSE NO. EXPIRATION DATE SERIAL NO. COMMONWEALTH OF MASSACHUSETTS�t PLUMBERS AND GASF FRS } LICENSED AS A JOURNEY, CAN PLU BER 4 ISSUES THE ABOVE LICENSE TO: t -DAVID W GARFIELD Y>vf 21 WILLOW ST N BROCKTON + MA 02301-1'4.51 t 23645 05/01/14 16t S94LICENSE NO. EXPIRATION DATE SERIAL NO. =: y Location 17q F // S /- No. Aj Date 3-3J-03 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �b D Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 02 d 17 Check # 13,13 61-60 -A tit ( C�--- Building Inspector I I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/IRS)wtor of Buildings Date 5 SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 170 ( Map Number Parcel Number 1.3 Zoning Information: Zoning DiAiiet Proposed Use 1.4 Property Dimensions: Lot Areas Fromage (ft) 1.6 WELDING SETBACKS (ft) Front Yard Side Yard Rear Yard RegWred Provide ReqWred Provided ReW'red Provided 1.7 Water Supply M.G.L.C.40 54) 1.5. Flood Zone Information: Public 0 Private 0 zone Outside Flood Zone 0 1.8 Sewerage Disposal System: municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 5 114 2%1 A r q E S, < I Name (Print) Address for Service : .,- J/1, ; /0— k— 68 2— G Signature Telephone.7 d 4- do ?'2 'd Z 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address *j q 7 t — _T 5 2 L/ Lp el;'� 1111 -1 -le Signature I I Telephone Not Applicable 0 License Number — t/;, — -- L/— 2 o 4 Expiration Date 3.2 Registered Home Improvement Contractor &_1K Not Applicable 0 57 Company Name et2 Registration Number q Address Expiration Date Signature Telephone OU M Z 0 I 0 Z M 90 0 mn ic r M rM r Z G) your SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildiig permit. Signed affidavit Attached Yes ....... Er No ....... 0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) r ti� Addition ❑ Accessory Bldg. ❑ Demolition 0" Other ❑ Specify Brief Description of Proposed Work: d -e fir eN kol,' 'k ti r �- Y-\ U .1W fl -114t,- iS/^'� - b0P* ee/ %,l-4Y-tfr SGtr-d ��di/rJ'f G �/ I PC'- �1 �1 M � � n 9 L •� ,0 i �+'� C �S' �C r rn , ` (/-1 'l yU r� S �: I -AJ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant-."', UFFICiALI7SE ONLY, s` , s 1. Building t U U G f (a) Building Permit Fee Multiplier 2 Electrical 3 U U (b) Estimated Total Cost of Construction 3 Plumbing 1/ 6 b Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 2 5 U " Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �iC A 1� A e ,A ✓o as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf. in all matters relative to work authorized by this building permit application. Signature of Owner .�J Date SECTION 7b OWNER/AUTIYORILED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1 2 3 y SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DILMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ACORDATE TM CERTIFICATE OF LIABILITY INSURANCE (MM/DDM 'YY) D03/27/2003 'RODUCER (781)438-5000 FAX (781)438-5028 New England Heritage Insurance Agency Group, Inc. DBA Robert F O'Neil Insurance 335 Main Street Stoneham, MA 02180 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # NSURED H. K. Builders, Inc. DBA Homecraft nstruction Co 88 Lake Shore Drive Georgetown, Ma. 01833-1927 INSURERA: First Financial Ins. Co. INSURERB: Maryland Casualty INSURERc: Guard Insurance Group INSURER D: INSURER E: -OVERAI;ES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. 4 -TR DDT NSR TYPE OF INSURANCE POLICY NUMBERPOLICY I DATE MM/DD/YY ION DATE MM/DD/YY LIMITS GENERAL LIABILITY TBA 05/01/2002 05/01/2003 EACH OCCURRENCE $ 1,000,000 7X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENT PREMISES Ea occurence $ 50,000 MED EXP (Any one person) $ S,000 CLAIMS MADE FR_1 OCCUR A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO CA90543489 05/01/2002 05/01/2003 COMBINED SINGLE LIMIT (Ea accident) $ (Per person) .- - 250,000 X ALL OWNED AUTOS SCHEDULED AUTOS B X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) 500,000 PROPERTY DAMAGE $ (Per accident) 100,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PRO PRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? HKWC401733 01/03/2003 01/03/2004 I 1111H TORY IC LIMITS ER E.L. EACH ACCIDENT S 500,000 E.L. DISEASE - EA EMPLOYEE S 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER t - r DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS general Contractor. CERTIFICATE HOLDER CANCELLATION Town of North Andover 27 Charles Street North Andover, MA ACORD 25 (2001/08) FAX: (978)352-7374 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. REPRESENTATIVE n ©ACORD CORPORATION 1988 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 001085 Birthdate: 06/24/1951 Expires: 06/24/2004 Tr. no: 24647 Restricted: 00 CRAIG F MEAD 88 LAKESHORE DR (�,..' - e tea, GEORGETOWN, MA 01833 Administrator t �,� �%re tat»nvnoiuocal,I� a�� . f�arca��a�,li4 u Rnai d of Huiiding Regulations :,nd �tandarde ii HOME IMPROVEMENT CONTRACTOR Registration: 100415 Expirati&i: 6/1$/04 Type: Private Corporation HK BUILDERS, INC. Craig Mead €1-3 LAKESHORE DR. Georgetown, MA 01833 Administrator North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A.. The debris will be dispose/d� of in: (Location of Facilit Signature of Permit Applicant 3- 24P- U'3 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*****"*********** ✓APPLICANT 5) Z,4 LOCATION: Assessor's Map Number D 7 U SUBDIVISION '--STREET % Y 67% ss l S t PHONE `1 7 k- PARCEL v LOT (S) QST. NUMBER ,% q ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMME TOWN PLANNER COM DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTI DRIVEWAY PERMIT ✓FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 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 0 I am an employer providing workers' compensation for my employees working on this job. Company name: Address ZA ��� S �► o r r 1�r - City a .1 rho w 41 s r Phone #: %% a 3 S z- L/ 6 W (*3 d ,5rgi Company name: Address City: Phone * Insurance Co. Policy # 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 andlor one years' imprisonment_as_well_as_chni.penattiesinshe%ncfaSTDP WORK ORDER..and_a.fine_cf�sioom)-arlay.gainstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and confect. Print name �e-4 t` ��� /l Phone.# 9 3 S Z - `/ 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 C]Check if immediate response is required .0 Licensing Board p Selectman's Office Contact person: Phone A- 0 Health Department O Other PROPOSAL HK Builders, Inc. d/b/a Homekraft Construction 88 Lake Shore Drive Georgetown, MA 01833 (978) 352-8468 Proposal Submitted To Phone Sheila Lynch (978) 682-6802 Street Job Name 74 Russell St. Same City, State, Zip Code Job Location No. Andover, MA 01845 Same Date 3/28/03 WE PROPOSE hereby to furnish material and labor complete in accordance with specifications below, for the sum of Twenty one thousand three hundred seventy eight dollars and 00/100 cents ($21,378.00). Payment to be made as follows: One third ($7,126.00) upon start of job, one third mid -way through job, and one third upon completion of job. All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized _ manner according to standard practices. Any alteration or deviation from specifications Signature1-'% below involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, acci- Note: This proposal may be withdrawn by us dents or delays beyond our control. Owner to carry fire, tomado, and other necessary if not accepted within 3 days. insurance. Our workers are fully covered by Workman's Compensation Insurance. We hereby submit specifications and estimates for: This contract includes the following: 2 X 4 wall framing, 1 X 3 strapping, 2X 10 LVL or equal support beams, exterior wall to be insulated with 3 1/2" fiberglass and vapor barrier, 1/2" blueboard applied on all walls and ceilings with one coat plaster system smooth. 1 X 4 belly casing, 1 X 6 base molding with 1" panel base cap, 1 X 4 sills and stop moldings. Contractor to be responsible for all rough and finish carpentry, demolition work, dumpster, and all clean-up, installation of cabinets, framing for toe kicks under new cabinets, and Formica counter tops, 2 1/4" crown molding installed along upper perimeter of wall cabinets, install all blueboard, interior trim, and installation of appliances as needed. Repair and sand existing wood floors. Electrical work: all rough and finish wiring including recessed light fixtures, sub panel in basement, changing electrical switches as specified, and new attic light and switch, dishwasher, and garage di5posel hook-ups, electrical switches and outlets. Plumbing work: fixture allowance of $750.00 includes ICtctxe %if11c, faucets, and garbage disposal. Rough and finish plumbing, piping, labor and permits. Plumber will disto-hhedt existing fixtures and will install drains, vents, and water piping. Existing steam radiator to remaig,, gasp line to be moved for stove hook-up. Homeowner to purchase kitchen cabinets and Formica tops. All labor, demo work, clean-up, plastering, building permit, and material unless otherwise specified in this contract, are the responsibility of H.K. Builders, Inc. All home improvements contractors and subcontractors engaged in home improvements contracting, unless specifically exempt from registration by provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108 #617-727-8698. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGLC 142A. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized / to do the work as specified. Payment will be made as outlined above. Sianature ��i La Date of acceptance: / G Signature, C/) m m C/) 0 m CA "o .00w z O O D. O Q =. A 0 o p CLCD cr CCD O •w 0. ag co CD CD -o CD 0 C3 Vi d 0 0 CO) n� 0 O c CO) d C) CD0 CD CD H. CD CO) 0 CD 0 CCD O -. cr N z i G 0 CD CA -i = m 0 ® C7 Z �mao a° N 91 ,, n oFn CD O 0 p y N N o m C D CA n a Z .0 . e'er 1 a N CO CO pa CL .. ••. CC,CD ` o o CD n CL m N. O 1•, = p� N . C/) _ C I CCD CA CD � V) t CD O � CA 0 oa r CD 0 C/) �� M CD ^• bd sm s r: = CD: d Cm N CD CU • 4 7: co- O o cn cn rn ?� Pi � � :h ?? � -n n 7* cn � o � T C w w �� M w w C O " ro "� a- rc �" �' i" S' S' R. GC n a ro Y COD rfl H � � 70 1 y 0 O C CD ►S � l Location 7-� ` %y �t°c.ss No. A5- C/0 Date 0 ORTN N.e TOWN OF NORTH ANDOVER ,:,h0 Certificate Occupancy + s of $ CMUsE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ �U C) TOTAL $ Check # 3s 41-10 17193 (%.�---,_-- Building Inspector Aft -1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI$ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING " _— BUILDING PERMIT NUMBER: DATE ISSUED: —141 —,p (-C�� SIGNATURE: for01 Building Commissione /I t f Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: /;7 a Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 0 Zoning Dial d Proposed Use Lot 4e&/(sf) Frontage W 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide ReqWred I Provided Required Provided 11 . 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: tion: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District. YeS 2.1 Owner of Record S� --y, � S^ AJC- A/ Name (Print) —7c;2-7� Address for Service: Signa re Telephone 2.2 Owner of Record: 41—M—e Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 K. Lrcl- C5—CA17��-S Licensed Construction Supefrisor: 14 License Number Address S�10202 –di f7J 6dO Expiration Dke Signature i9vTejpphone OF7J Ja71666 3.270egistered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date I Signature Telephone Aft -1 SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building P1 Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 2 F 41 uv a0 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building c 7 O O (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction q G `� 3 Plumbing Building Permit fee (a) X tbl / 4 Mechanical IIVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, S� vA C,._ , as Owner/Authorized Agent of subject property Hereby authorize to act on I IZe calf, in ap mattvgrs relative to work authorized by this building permit application. Signature of Owner Date T�— SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ��� �� (� 1. ��� as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Pri Name Si ^ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB A Sc ^s SIZE OF FLOOR TIMBERS 2 3 RD SPAN I DIMENSIONS OF SILLS DIMENSIONS OF POSTS X DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING i O z ` X MATERIAL OF CH11v1NEY IS BUILDING ON SOLID OR FILLED LAND Jo (, IS BUILDING CONNECTED TO NATURAL GAS LINE F ( l A 11'.Y: ICAC CI](aac �I I 1 I CERTIFY MAT TIIIS LOT IS NOT IN TIIE F.I-A. FLOODZONE. 11115 CERTIFICATION IS BASED ON THE SURVEY MARKERS OF 0111ERS AND IS NOT A PROPERTY SURVEY, FOR MORTGAGE PURPOSES ONLY. I CERTIFY 111A1 TIIE BUILDINGS ARE LOCATED AS SHOWN AND, IIIAT 1'IIEY CONI`0 MED TO TIIE ZONBJG BY-LAWS OF IIIE CITY/TOWN OF .1y1j����yS� �rl(�WHEN CONSTRUCIED. SCALE: 11, = ' �ZN or � DEED 8001( �� S? PAGE 3O(`) s AREA i,300 s � �Ofilll$ PLAN d'-�-�� M0. 22150 g FcisiEaE°" ASSESSOR MAP BLOCK LOT CAS 1 - I Is, V CERTIFIED PLOT PLAN OF LAND AT AS DRAWN FOR: mt 5a>(arc-�s1t ochumette 01830 rnx:(A7e)1rb71e3 �_. rrvpvsai Licensed Over 20 Years Experience S ;and S Building &-Remodeling +.. Kitchen • Baths • Custom Woodwork `F BOB STEPHENSON Complete Interior/Exterior Carpentry 11 Bixby Ave. (978) 688-8097 No. Andover, MA 01845 NAME OF OWNER," = : — A fes' r ADDRESS OF JOB �r F� r' TEL. t f GI' DATE: We hereby submit estimates for: -'al C ��� ilL is c!F'(i' j J sh l .� f e !� /{ "pf! i 'S v S- t) Gni..+ or- - p A 7 d 5`' W c :�' �'i C. c :�� .SM tri �'r "%•%/pt r /`t ,' % ,'v j r 70 We Propose hereby to furnish material and lab/or - complete in accordance with above specifications, for the sum of: 0C"5'lei ;�.c (-f dollars ($ Payment to be made as follows: 7f�- 'r -c a fr., i. r_.1 i .i't (.7 �f •rr� ; p„p t � All material is guaranteed to be as specified. All work to be completed in a _ workmanlike manner according to standard practices. Any alteration or devia- Authorized tion from above specification involving extra cost will be executed only upon Signature written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, weather or delays beyond NOTE: This proposal may be our control. Owner to carry fire, tomado and other necessary insurance. Our withdrawn by us if not accepted within days. workers are fully covered by Workmen's compensation Insurance. Acceptance of Proposal — The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature � �� '.��..( �."•.. s�.,r\..-�.-..�`''r.,� Date of Acceptance: Signature�r�.�t~"%' A�`ti, r' Name: Location: The Commonwealth of Massachusetts . . Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers` Compensation .Insurance Afftwit City Phone # QI 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 wmiting on this jtiix F9&m to semw coverage as mqulred wKW SeeWn 2aA cr MSL pwwmks c a fit anttlor one years' br�priaarMr�nt as_rbeltas cosina�es�n lbeZorm��l�FKDRUERAxta.tee�if CL1�j awl understand that a copy of this staterneM may be forwarded to the cwm:wbf bmrestigabons cf the Db4for dowdage mon. 4 nb herby certiy wx1,r Me peens and perwfts oflilwy flint the" miafta provAled above is &w andeonxt Print name �Q J r• Official use only do not write in Ws area to be completed by city cr town dfk: ar CiY 4t Towr► D Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be ,K disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of acility) Signature o Permit Applicant Date. NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector J. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 011353 Birthdate: 05/22/1951 Expires: 05/22/2002 Tr. no: 26468 Restricted To: 00 ROBERT A STEPHENSON 11 BIXBY AVE N ANDOVER, MA 01845 Administrator CA m m m YI m m y 'O 'OCl) Z CD O ar d� CL aco o v a� C7 CDo D Cl O Cp CD CA 10 CD M 0 CO) �v d O CO) 10 C�. C O y d n CD O CD CD a FW CD CO2 0 CD 0 CD dc c :T.,O s 8 -'y c Q N �- E c So CO) 'a� m CL Say' es O� ._► ? C .d-► CLT a .. =r0 r► ® H %1 O -40 N 0�m m = ® _ �-0 o n CD /► al m p ...r on O y. C9 c a = .R S. j = 06 Cn C co C', 'nom : �1 CTi y d co a mIL Pd C/) o O - /^ 06 H t H �"• VJ m a ob = CD O O cn Q m o 1 t cn Ory d r �� a �1 C4() o o w w n w ow "C7 r a' G A". " GJ .� r d(DrD 'd �" °o CL n M W) I t H 0 O C CD ►Y