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Miscellaneous - 74 AUTRAN AVENUE 4/30/2018
P-11 LibertyMutual, r• July 1, 2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 74 Autran Ave, North Andover, Ma 01845 Policy Number: H3121824087640 Underwriting Company: Liberty Mutual Insurance Company Claim Number: 032098061-0001 Date of Loss: 2/28/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, � 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, X99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, § 9, or Mass. General Laws, Ch. 111, 5 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 A t Date ...?.............. . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..........�1 v i .. ............. J. /.....7..................................... has permission to perform ... . Z7'/ L �f� • f r' wifing in the building of......... fw % ! `'L at...........................r C'North Andover, lVlass. ................... .Fee.......!............ Lic. No?of-���...�.,0.�.�.............l...-�.............�.. .. ....... .... G % E�LtcnuCAL INSPECTOif Check # 122/411 M - --C\- C.ccommoruaeaGttt o�ccl�aac�iuself� eLJePaal'araeni o�..i'ire �ervice;! BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 2 Occupancy and Fee Checked [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3 12 / 1/ zl City or Town -of: �rj,Q7Yj 1441nelae}e To the Inspect ro o Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) -7,— ,¢I/R, 4 Aie- Owner or Tenantu/�t,, ajp�/ L.¢/2� 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: A/0Qr Completion ofthe 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 Above In- Swimming Pool rnd. ❑ rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets r No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners 2 No. of Detection and Initiatin Devices No. of Ranges �/ No. of Air Cond. 2. Tonal / No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I Number - ---------- Tons - - --� KW --------------.. No. of Self -Contained / 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 Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail !f 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. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: DAV I 'D l: L G (_ T R i CA L LIC. NO.: Licensee: -D A\/ t D 14466 4P Signature LIC. NO.: � li Cl & (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.:9 '1 F -66 4"Q_(72 Address: A-7 ie3t:L1nDN_r NORTO Jt1JDUv:r2 i111} U `i Alt. Tel.No.•!J-10 -375-5-1 *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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Z3.3 3- IX F The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: DAVID ELECTRICAL CONTRACTING LLC Address: 87 BELMONT ST City/State/Zip: NORTH ANDOVER, MA 01845 Phone #: 978-682-6262 Are you an employer? Check the appropriate bog: 1.9 I am a employer with 8 employees (full and/ or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, §1(4), and we have no employees. [No workers' comp. insurance required]** 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] Business Type (required): 5. ❑ Retail 6. ❑ Restaurant/Bar/Eating Establishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) 8. ❑ Non-profit 9. ❑ Entertainment 10. ❑ Manufacturing 11.❑ Health Care 12.0 Other ELECTRICAL CONTACTING *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. **If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box # 1. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: FEDERATED MUTUAL INSURANCE CO Insurer's Address: PO BOX328 City/State/Zip: OWATONNA, MN. 55060 Policy # or Self -ins. Lic. # 9353694 Expiration Date: MARCH 1, 2015 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 t e a' a flies of perjury that the information provided above is true and correct Signature: �— Date: U/ev/�/ 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. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone #: www.mass.gov/dia 0' 1044.1 Date .... ..l..j 1,10. 11q....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING "This certifies that ..... ....... 1... has permission to perform ..........I-- ---- e.-.4 ...................... : .............. plumbing in the buildings of .................................................................. at ..... ...... .............................. ................... Norh Andover, Mass. Fee... Lic. No. M.0 ................................................................... PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY h0 iJ L _ MA DATEill PERMIT# ` ( JOBSITE ADDRESS �L/�U_ ]�,[�,(� V� OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL] EDUCATIONAL © RESIDENTIAL-'� PRINT CLEARLY NEW: RENOVATION: 0 REPLACEMENT. -El' PLANS SUBMITTED: YES Q NOQ FIXTURES 7. FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER I DRINKING FOUNTAIN _ i ..--_--- .----,_! -.----i _ { I _1 FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN I I SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION._.__.._3 E _.____4 __-__ _ _ p WATL-R HEATER ALL TYPES WATER PIPING OT CER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ,. , NO El IF YOU CHECKED YES, PLEASE INDICATE THE TY E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW C= LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND] 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 Q AGENT 10 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 an to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliary all PrtlnTtpLovlslon of the (Massachusetts 1 State Plumbing Code and Chap er 142 of the Gt neral Laws. / , S PLUMBER'S NAMEI LICENSE #1 „-_ I IGNA RE 1 IMPEr�JPEll l�(D� CORPORATIONW#PARTNERSHIPU#L_LLC© COMPANY NAME _ /� Z: ; ADDRESS - L CITY/tl�-Il r�U I STATE ZIP L�/ �S�— it TEL AO FAX CELL EMAIL ---------- - - - --- -- -- -- ---- - °� o rl z F- w m iii LU Date ...$. .................. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. P....:.p.�`?` . .......................................................... has permission for gas installatrrion .... e, rr,jA c . .... in the buildings o L.�. `i' �-e u R.- � ...................................................................................... ................... ,,! ........ . at.......,......?!`1......`'�.............{{..��......, North Andover, Mass. Fee........'. Lic. No..�'?Z.1..2.,.......!....�........................................................ GAS INSPECTOR Check # � �'� 9157 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ° CITY MA DATE % e PERMIT # a JOBSITE ADDRESS OWNER'S 6AME-G U OWNER ADDRESS TEL — ::77j FAX [__ TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: El REPLACEMENT: ® PLANS SUBMITTED: YES 0 N09--' APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 I _ I ._ . BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER r� DRYERs� FIREPLACE FRYOLATOR FURNACE ✓ GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER _ ROOM / SPACE HEATER ROOF TOP UNIT TEST ---- I �— - UNIT HEATER _ UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E3--' OTHER TYPE INDEMNITY © BOND �[] 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 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and a ur to the best of my knowledge and that all plumbing work and installations performed under the permit iss ed for this application will be in compliance h I ert' t pr vis' the Massachusetts State Plumbing Code and Chapter 142 o ,the General La PLUMBER-GASFITTER NAME _ r LICENSE # ISIGNATUR MP N2/MGF [� JP [3 JGF LPGI CORPORATION ✓f# PARTNERSHIP 0#LLC E]# COMPANY NAME: C _L[. /� / N [� �. ADDRESS CITY STATE 1h/ ZIP / TEL r( _ FAX CELL ��_ EMAIL 0 H U' W W W z� O N F,_ W U w Z I- a Q w co a O � w w CO g a a a U ' J F, a IL CO ui x w H LL H 0 Z H h U P64 Una The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ 600 Washington Street Boston, MA 02111 m-minass.gov/dia `Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2ibl �4 / 1 tiriTlle (Business/Organization/Individual): 3" Address: _%"i City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. J am a employer with in `. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.+ required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t ❑ We are a corporation and its officers have exe;cised their right of exemption per IvIGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling - S. ❑ Demolition 9. ❑ Building addition 10. E:1 Electrical repairs or additions I 1.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also till out the section below showing their workers' compensation policy information. ' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subinit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I cin an employer that isproviding workers' compensation insurance for my employees. Below is the policy and job site information. r'I- . . . Insurance Company Naive:_ G`lu�� ,,.�hJr,/ Policy # or Self -ins. Lic. #: —Z/ 7 j / Expiration Dais. C/1 - Job _ Job Site Address: 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 tip 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. Ido hereby certif ittder the pains and penalties of perjury that the information provided above is true and correct Phone#: 9%J 2 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 #: a COMMONWEALTH OF MASSACHUSETTS PLUIVIBEF S ANC) GASFITTERS` , LICENSED _ ►S A Int t- STER PLUMBER ISSUES THE ABOVE LICENSE TO: JEFFREY- P I'M TNIC," r G0 PLYNOUTH ST :MET 14UEPJ MA )1344-4256 15212 �J /OIl14 147804 COAr1MONWEALTH OF MASSACHUSETTS PLi,INIBERS AND GASFITTERS LICEN"ED AS A JOURNEYMAN PLtJAlIBER fSSUES THE ABOVE UCE,jNSE TO _)"FERE P HUTPdICK 61 PLYVIUTH ST. IN, IM tE HUEN MA 01844 4 256 _21881 05/01/14 147803 Location l V►" No. f Date S Check # r�3� 27275 TOWN OF NORTH ANDOVER Certificate of Occupancy $,_ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: P RTANT: Applicant must complete all items on this page LOCATIONN .� 7 Print, PROPERTY l,.t. 417, PROPERTY OWNER 4 4- - Print 100 Year Old Structure yes no MAP NO ARCEL: ONING DISTRICT _ Historic District ye no 'Machine Shop, Village: yes no .TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family- ❑ Industrial Ca -Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other q Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District o Water/Sewer DESCRIPTION OF WORK TO BE PERFOKmtu: OWNER: Name: %SAN' Ar4Arccc• n Please Type or Print Clearly) CONTRACTOR Name: ` -�5 .I iu"� Phone: zly 1-21-G 7`f Address: Supervisor's Construction License: GS (aS-(� `� Exp. Date:1(�?-° 15� Home Improvement License: f_4, (- _ Exp. Date: / �Z__/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASEDON $125.00 PER S.F. Total Project Cost: $H'o 0 D FEE: $ Check No.: � 4 3- -x_ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to a guaran fund -Ile Signature=of�Agen O ne'r' Signature of contract _ Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 11 Building Department The foL"pwing is -a list of the required.forms to be filled out for: the appropriate. permit to be obtained. Roofilag, Siding, Interior Rehabilitation Permits ❑ ' B' ilding Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.1.C. And/Or C.S.L. Licenses ❑ Copy of Contract a 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 ❑ Building Permit Application a Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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 ❑ 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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buil,jffig Permit Revised 2012 Plans Submitted ❑ Plans=lNaived,❑ Certified Plot Plan ❑ Stamped Plans ❑ - TYPE�OF°-SEWERAGEDISP_O.SAL" Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. 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 PLANNING & DEVELOPMENT ❑ DATE:APPR.OVED _El COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature d COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW 'Todd:: Engineer: Signature: FIRE DEPAkTM;r-_NT-Temp Dump'ster onsite :yes Located at;.124,Mair Street =` Fire"Departmeri signatb'r_e/date . sir COMMENTS Located 384 Osgood Street no .-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 DANGERZONE LITERATURE: Yes No MGL -Chapter -166 Section 21A -F and G min.$100-$1000 .fine NU I LS and DATA — (For department use U Notified for pickup - Date Doc.Building Permit Revised 2010 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 14,000.00 m $ - $ 168.00 Plumbing Fee $ 21.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 21.00 Total fees collected $ 310.00 74 Autran Avenue 578-14 on 2/5/2014 Remodel 2 Baths 0 LLI= O m C tL u, "6 0 O LL E AJ N U j... CL w (n cr G W H Z z n m C .2 m 'O C O LL L GA O cr ai C L U C LL o N ? C7 Z ca g J d L GA 3m O W C LL a H ? Q u u J W L GA O d' O A� N C LL o U a Z _ on LGA O K C LL W nQ G cc a:N L N i 7 m O Z N w N v ai Y O C Ln n rVrwi .a �I CCS o ca O M p V ui � a z ' r c Z IE .=yam Cl) < E C � L M' c, V tiN L (n 10 MH J L I C- Z ~ �.`•�_ Cl)� = d fn W li 0 5d> �. 00 O � QEoc oo (D �U) - h T r- W d 'QCD z m V r+ = O Cl) O C r O w0 a = CO) Qpm � o CO)cc �. .. W = 'a � O O ,� Li C C to = O .w ,Q N .r ui:E �O Z e W .E __� L V d O U d H x w o = o I-- = CL 0 U > 9 0-1 w N ti E CDZ N N .E L O t v _cc a. to V N i V cc cc 00 L O CL CL �a CcCc J O d Z CLN c ]E OMP-owm,eromm a- tion n vnIid rcgistratian nnmUcr ... G � �- L�r //Z �/� The Contractor agrees to do the following worlz-for th $ l s (Descnbeuldetailtheworlcto completed Iefed s ec' a ameowner: P , p ifyingthe type, brand, and grade of materials to be used, -1190 additional she ifnecessa Required Permits - The follgwing building permits are required and will b e secured by the contractor as•the homeowner's agent: (OW-,ers Who secure their oW n permits:WM be excludedfrom 'tTie Guaranty Fund provisions o:C :KGJL chapter 142,A.) Proposed Startand Completion be Schedule --The following schedule Will, adhered to unless circumstances beyond the contractor's control arise Date when contractor Will begin, contracted work. Date when contracted work will be substantially completed. Toial ContraetPrice and Payment Schedule The Contractor agrees to perform the work, ;Cornish the material and Iabor speci;Med above for the total sum of /7;o Payments will be'mad e accoxding to the following schedule: s (�) upon. signing contract (sotto exceed 1/3 bfthe total contxactprice or the cost of special order items, .Whichever is greater $ J by 2 / _ �// ) or upon, completion of G"vi� • by Y or upon completion, ac upon completion, ofthe contract, (Law forbids demanding full payment until contract is completed to both party's satisfaction) The foilowingmateriaVequipmentmustbespecial orderedbefore the contracted work begins in order to be paid for to meetthe completion schedule,('° ) to be paid for NOTES, (") Including all finance charges" requires that any deposit or down p �) ed by the contractor before ayment requir not exceed the greafpr of (a) one third of the total contract price or (b) the actual cost of any special equade may material which must be special ordered in advance to meet the completion schedule. ipment or custom m Subcon%tactors -The contractor agreesLto be solelyresponsibled:orrcompletion of the work described regardless ofthe actions ebed third No es aII terms o£the warran must be attached fo the contract of party/subcontractx utilized Tiy the contractor. T$e contractor fiuther agrees to be solely responsible for all a y mate and aborilnderthis a eement Contract Acceptance - upon signing, p Yments to all subcontractors for p going, this documentbecome.s abinding contract under law- Unless otherwise noted within this document, the contract shalt net imply ring this any lzen or other security interest has been placed on the residence. Review the following cautions and notices earefuliy before signing this contract. ° Don'tbepressuredinto signing going the contract, Take time to read and folly understand it. Aslc questions if something is unclear., Make sure the actor has a valid Tome Tin rovement Contractor R egiter, .., subcontractors to ba registered with the Director of$ome Improvement Contractor Reg�str lcqution. you most m nim about improvement The lawrequires most home improvement contractors and registration by contractor g e •itsur ector at 10 Searlcl'iaza, Room 51701:8 oston, MA .02116 or by calliug,617-973-8787 or 888 283-3757, ° Does the contractor have insurance? Ask the Contractor fdr his insurance company information so that yo. can confuxn co e see a copy of a "proof ofinsurance" document.v rage, or aslcto ° l'�uow our ri is and re onsibitities. Read the im ortaut Information on the reverse side of this form and et a Y gh � Guide to the Dome Improvement Contractor Law; p • g copy of the Consumer FIZ�rd ay cancel tUis agreement if it has been signed at a place other than the contractors noz7rtal place of business, provided you ctor es writing at his/her main of�ace or branch office by ordinary mail posted, by telegram sent or by delivery, not Rater than midnight o usiness clay followi, the sq Y notify the g going oftbis agreement. Seethe attached notice oCcanceliaiionform for an explanation oftha right, f the ®1�T®7['', IGN 7 MI S CO NT��ACT' g' '�`a3ERE Two idenfical copies o£tlta coniractmust be completed and signed, One copy should go to the lI e ARE ANY �LAM�$ ` cr's Infractor. P9 s P:[o eownex's Signal, �C%�• Contractor's Signature 'Date Date Comraetolr A -A trition. The Home 7xnp%ovement Coxrtractor Law provides homeowners with the right to initiate aro arbitration action (as ars alternative to court 'action) if they have a dispute with a contractor. The same ri t rs I. contractor., however, The contractor would have to resolve any dispute he/she has with a hUtOm Nynex y .for edto a both paries agree to the option,all clause provided below, This clause would give'i-he contractor the same xightu unless arlaiiration as is afforded to the home the Home Inprto ovement Contractor Law. The contractor and the homeowner herebykutaally agree in advance thatcOnthe event the contractor has a dis ute he e rret this contract; the contractor may submit the dispute to a private arbitxanon fix�i which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration' as.provided In Massachusetts Genera]. Laws, ch r 142A., Homeowner`s Si attiu•e Contractor`s Signaititre NOTICE- The signatures of the parties above apply onlyto the agreement of the patties to alternative disute resolution initiated by the contractor,. The homeowner may initiate alternative dispute resolution even p section isnot separately signed by the laarties. where this M19meown.er's Rights A ]iomeowner`s rights under the home In Contractor Lpw.(MOL chapter 142A) and other consumer protectxoaa:laws (" MGL chapter 93A) may not be waived in. anyway, even by agreement. I:Iowever, homeowners may be, excluded from certain rights if tl?.e contractor they choose is not properly a egistered as prescribed bylaw. Homeowners omeoers who secure their own building permits are automatically excluded- om all Guaranty Fund provisions of the Home Improvement Contractor -Law. The contractor is• responsible for completing the wort, as described, in a timely and worlman]il,e manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials, In addition to provided by the contractor, all gratis sOld.in Massachusetts cavy an implied warranty of merchatneta il�itwand warranties for a paxcular purpose. An entixmeration of other matters on which the homeowner and contractor lawfully agree maybe added to the terms of the contract as long as'they do not restrict a homeowner's basic consumer rights. If your have questions aboutyour consumer/homeownerrights, contact the Consumer W, 01-n.aiionI:Iotliue (listed below). ]Execuutiion. of Contract The contract mast be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been -attached. Parties are. also advised not to sign the document until all blank, sections have been Media or marked as void, deleted, or not applicable. One ori ginal signed copy of the contract with attachments is to be given, to the owner and the other kept by the contractor. Any modification to the, original, contract must be in writing and agreed to by both parities. Contracted work, may not begin urotil both parties have received a fully executed copy of -the contract, and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance ofthe dates specified on the•payment schedule in cases where the homeowner deems him/Jaerselfto be financially insecure. However, is instances where a contractor deems hjm&where rself to be financially insecure, the contractor may require that the balance of :Rzids not yet due be placed in a j oiitt escrow account as a prerequisite to continuing the contracted work,. Withdrawal of fLinds Crom said account Would require the signatures ofbothparties. Addiiiomal info:rmation. ,Tf yort have general questions or need additional in:Corination about the Rome Improvement Contractor Law or other Consumer rights, or if you wish to obtain a free copy of "A Massachttseits Const�n Consumer msnt to Home 7snprovr other contact:ntm Consumer InformationHotline Office of Consumer Affairs and Business Regulation 10 I?ark Plaz�, ROOM 5170, 33 02116 617-.973-8787,'888-283-3757 or"visittthe OCABRwebs ie a _gig_ locaUr! If you want toverity the registration of a contractor about the conntractor registration compor i:f yot*. have questxoaa.s or need additionalinfozmatxon speeif[caily aonent of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registr'a-Liaa O C-f'ice of Consumer Affairs and•Business Regdation a , Room 5170, 617-973-8787, 888-283-3757 or visit the MC Website'atbi 02/ 16 bitp:Go online, to view the status of a Home Improvement Contractor's Registration: , ht;7x//dU.state.ma.t2s/hoz �eimorovelr�ent/iicenQe IT -4. For assistance with informal, mediation of disputes or to register formal complaints against a business call: Consumer Complaint Section Office of the Attoaney General 617-727-8400 AND/OR Better Business Bureau. 508-652-4800, 508-755 2548 or 413-734-3114 Its Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration PAULS HOME SERVICES LLC. PAUL SHAPLEIGH 7 STROUT AVE. .LYNNFIELD, MA 01940 3CA 1 0 20M-05/11 Registration: 168261 T e: LLC - tkN' `=r, Expiration: 1/24/2015 Tr# 235201 �` y s�•�if pdate Address and return card. Mark reason for change. -- Address ❑ Renewal 0 Employment ❑ Lost Card &tee Womzirno eveall g1b4 aoaac1juaedl. Office of Consumer Affairs & Business Regulation License or registration valid for individul use only. ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: X8261 Type: Office of Consumer Affairs and Business Regulation ~" xpiration: ��24120110 Park Plaza - Suite 5170 .5 = LLC Boston, MA 02116 'AULS HOME SERVICESTLLC i -i - 'AUL SHAPLEIGH r STROUT AVE. -YNNFIELD, MA 01940 Undersecretary Not valid without signatu Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS -105174 PAUL S SHAPLEI6H 7 STROUT AVE ° LYNNFMLD M� 019�a0; Expiration Commissioner 11 /20/2015 The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 www.mass.gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information % Please Print Legibly Name (Business/Organi'zation&dividuai): Address: -Z-0— City/State/Zip: Phone #: 7y/ Z`f / Z k'7 Are yo n employer? Check the appropriate box: 1.W am a employer with 4. ElI am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2111 am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §I(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. T 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 andjob site information. Insurance Company Name: Policy # or Self -ins. Lie. #: L)f3 L-77 -V 2 Expiration Date: /,5 l Job Site Address: '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 requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a ;Cine 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 certou der the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town 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 agepey 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 ofpublic 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' compensaiion affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificates) 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 maybe 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 aworkers' 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 contacUyou 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 Ma ssarhvseffs Dopartment of Industrial Accidents Offtoe othwestigations 600 Washiu n Ste,,t Boston, MA 02111 T01. # 617-7-27-4900 oxt 406 or 1-877-MASSAFF, Devised 5-26-05 Fax # 617-727-7749 ww�vax�ass,govf�;ia, � T►/ CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER 617.776.1640 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MASSACHUSETTS INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 255 ELM ST. SUITE 200 SOMERVILLE, MA 02144 _ INSURERS AFFORDING COVERAGE I NAIC # INSURED INSURER NAU T LIS PAULS HOME SERVICES LP 1 INSURER r 7 STROUT AVE INSURER C' LYNNFIELD. MA 01940 INSURERD I INSURER E. + rnvcOAr_ce THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTV41THSTANDING ANY REOUIREMENT, 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. �LNSR ` - ADD'l POLICY EFFECTIVE POLICYEXPIRATION I LTR !MORD TYPE 0F!14 UBANCE POLICYNUMBER _ DATE rPA•? rDD1YY1 GATE UtS'rDD!YY I LIMITS ` GENEP.ALLIABILITY EACHOCCURRENCE 11000,000 x1$98 Q5%OSO3 O5i132014 I iS EtISEStg c .�____ 1O0.OiOCOMMERCIALGEINERALLIABILITv CLAIMS MADE X OCCUR ' MED EXP (Any one person) is 5000 I I I PERSONAL& ADV INJURY S 1 000,000 GENERALAGGREGATE .S Z,O00,000 I I GENLAGGREGATE LIMIT APPLIES PER i PRODUCTS •COIdPOPAGG I S 01,000,000 i . POLICY ^ PRO, r� I 11 IT LOC I I AUTOMOBILE LIABILITY I COMBINED BINED SINGLE LIMIT S (Ea accident ANY AUTO { I ) ALLOWNED AUTOSI ) BODILY INJURY S SCHEDULED AUTOS I I (Per parson) HIRED AUTOS BODILY INJURY $ NON,OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY ( I AUTO ONLY - EA ACCIDENT S ANY AUTO i OTHER THAN EA ACC S AUTO ONLY AGG ( S Ir EXCESS/UMBRELLA LIABILITY I EACHOCCURREN_CE S OCCUR CLAIMS MADE ; AGGREGATE S S I t ---j DEDUCTIBLE � S RETENTION S S WORKERS COMPENSATION AND ' I WCSLjMIT OTN . ER EMPLOYERS'LIABILITY ANY PROPRIETORtPARTNER--EXECUTIVE ACH.A CID EL EACH ACCIDENT S OFFICER MEMBER EXCLUDED' I E L DISEASE - EA EMPLOYEE! S I! yyaes, desc," under SP'cCIALPROVISIONS below E L. DISEASE • POLICY LIMIT S OTHER ' f 1 , DESCRIPTIO14 OF OPERATIONS / LOCATIONS /VEHICLES /EX.CLUSIONS ADDED BY EHOORSEVEI� 1 f SPECIAL PROVISIONS 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION + DATE THEREOF, THE ISSUING INSURER V. -ILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL. LAURELL E"LLOIT IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTA N AUTHORIZED\ PRESENTATIVE ACORD 25 (2001/08) ' ACORD CORPORATION 1988 9060 Date. S '.1 .tet.:. f. I . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that A�.C!k3X!.T.... S`I.M.`t �.j : `. � ..'...... . has permission to perform .. /j?� ^°-..'��i-`}-!!'�� ....... plumbing in thee, buildings of ..:. Cy"i �- !^� ��Cr.. V!n�. S' at ... �q... 1.'.(�.�. �� ;� .. ......... North Andover, Mass. Fee.37',-c.0 . Lic. No..5.3.3 -3. ....... /.�— —_C—"�%v.. ... PLUMBING INSPECTOR Check # 1 /53') r1N— E9 Wdl/ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town. , MA. Date: �1��� Permit# Building Location:Namer 114l Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential LrJ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: V Plans Submitted: Yes ❑ No ❑ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes Q'416 ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy R Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Aaent Owner E] Agent i nereoy certlty that all of the details and information l 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 hermit issued for chic annrrnfinn —m tie t., rvrunanc provision or me massacnusetts state Plumbing Code and Chapter 142 of the General LaVA& By Type of License: L c /Yf1/YY1� Title ❑ Plumber Skffature of -Licensed umber City/Town ®?Waster APPROVED (OFFICE USE ONLY) ❑Journeyman License Number: [� 0 I DEDICATED W Z SYSTEMS CA 0 cc Z 4A N in D a 4A LU Z Z h S N W Z W Z F- H Q Z Q� oe N N W `9 Q N Q Z OC Q Z W Z �_ a 3 tL H 3 O 0: 3 W l' -h W J .J Z LU LU LU ce O W W a H R Q m m o H O O e x H > > g g. O O O H Z o LL x v=i ia- 3 3 3 a Q l7 3 SUB BSMT. BASEMENT ST 1 FLOOR 2ND FLOOR 3" FLOOR 4r" FLOOR S FLOOR e FLOOR 7 FLOOR 8 FLOOR _... Installing Check One Only Certificate # Company Name: �' L [}e'&rporation Address: City/Town: AState: ❑ Partnership Business Tel 00� Fax: ❑ Firm/Company Name of Licensed Plumber: V.0 16,14 S ammah��� I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes Q'416 ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy R Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Aaent Owner E] Agent i nereoy certlty that all of the details and information l 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 hermit issued for chic annrrnfinn —m tie t., rvrunanc provision or me massacnusetts state Plumbing Code and Chapter 142 of the General LaVA& By Type of License: L c /Yf1/YY1� Title ❑ Plumber Skffature of -Licensed umber City/Town ®?Waster APPROVED (OFFICE USE ONLY) ❑Journeyman License Number: [� 0 I -Location No. 1 / y Date - `f °R*►► TOWN OF NORTH ANDOVER Certificate of Occupancy $ * ; Building/Frame Permit Fee $ sACMu Eta' Foun//datio Permit Fe $ v Othr�e $ U Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector 7Q 7311 06/02/94 09:46 Div _ Public Works %A qA Q p� XEW UA > Oc Z IIL p � m a_. z O LL O p V W N i c � O w O N 0 Z m J N O Z W m 0 O O F - W d Q II' n _C Wn, ~ Z M IL 'o 0 � F E o z p f„ 0 } v } tom"w W f Ir D p F < z a < p r a W' z Nz . 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C, o $--- — L kc PROPOSAL To r-1 Ro � t' (& rs 51 11F1'Lkr1 Sr Ne-( kc(er7, l4k'.01?Z1V TSL, CYC- -35JY PROPOSAL SUBMITTED TO: nnPROPOSAL NO. r?T rc _Too_ Too_ Wo, l oc '57<733 SHEET NO. �DATE �z��Z WORK TO BE PERFORMED AT: f r J ADDRESS DATE OF PLANS ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of oif r4 ,�„ 'f' r_ C L All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars ($l/e0,7' �6 ) with payments to be made as follows. . t -t Fu I ( UP 0r7 c o rY\ P 1 ,�- Trr© 1-7 f � J ' Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents, or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date Signature Adams NC 3818-50 Ptr'oposa0 MADE IN USA. xU w a 0 aG w° C/) ,u� cn 94 o w z z Cp •• 0 U z xU w a 0 aG w° C/) ,u� cn 94 o w z z Cp 00 cuv W. ao 0° U �s w z z RW,, w°' ro w a O z aa U U W W � u C/) w x w C7 0° w z a ¢ w a W' v ° z w V) D ° cn Cd c c •CO c :oma C.3 71 lk N= �0 Y Q :: c ° �s 4 0 r N v. �QO E _ i- o` w <L ,o Q' c G �• O o c� ^3�13, aN d m co67 N cm ' C 67 C � m CA MC N co w o av L - N N N INV _416 C H Q ac Ci • V y O �z .. c o 0 a� .�h ac CL N m COD ~ •N 'O.t O C � {� .E C', •O v 07 C. o o O o D C CLy o. m .� .o 2 A §-= 'O 0 CA y .co L 0 CD CO) 0 CO2 C O C..7 •c CO2 r_ -I L 0 ts co Q. CO) c CO CM C OCo •� mm 0 C13 L co o O Q Q �a C *--a C C Cc J -C CO Z co H C J Q z LL - z 0 Q w Cn z 0 U ii Z Z J 00 w Cc F— M LU Q W Cc D J Q Z W Q W W U) _ _ � r -.... -_ rte.,+, r .. -. ' •' � _ - ._ . _ Location 771- %� N UiVA S Aq F - No. 1-74 - W -S-. Date NpRTh TOWN OF NORTH ANDOVER pfyc ,•1h0 i • CL Certificate of Occupancy $ } Building/Frame Permit Fee $ SACMUs Foundati(��n(Permit Fee $ Other PeO#ir4-$ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �,C�, �$�O� Building Inspector 0914 M 13• 8759 15.40 PAID Div. Public Works {A d 0 o u I t C : : �. �� � p� W W z n 0 W I> I G Z I&L to m y J J m Q 0 J f O d n W a I a C W OLLm = O 0 0 0 0 f O V Z N 4 W IL z O W W W Q N Y Z m N W (L y f O I U m 0 O u S W Z_ a Z ~ x Z J N 09 0 S d Ip N I QkL F W O Q 3 0 t � Zz v v z < V 1~ > 1!J d W 10 �J i 3 m < {A d o u I t : : �. �� � p� W W z 0 W I> I G Z I&L z c m y J J m Q 0 J f O a n W a I a C W OLLm = O 0 0 0 0 f O V Z N 4 W IL N O W W W Q N Z m N W (L y f O I m 0 O u a F� Z 09 0 S d QkL Q 0 t �z Zz v v V 1~ > 1!J d W 10 �J it Z0 x z O I! I� 2 OJ J W u �N �� m L 3 y F y0i Z C W W ¢ f W < < W z f z {� F r ZZ<i-zo4 t- II O 0 m m m W rc U U z 0 T W a Q m W ~ O Z < p z Z i u 0 z z x o t 0 f. r0i m t J `tom ` o < Ci 1F D W 0 M > Z- V < a II W 0 m p t O I N Z 0 > WK w < Z E O ZO I D Z U 0 0 0 . 0 W 4 = 0 a li W W F W ~ < Z W i W S O < < WZ C Z 0 It 4 N W O N I N W z J ZO 0 M J I W O Z < ¢ F ', L 0Z z Z O N W m m m A I 0 U ,� i 7 at %ft %& V uj LU � � J W Fce a z z z V ���< o u I t : : �. �� � Z 0 f f f O W t } V I 0 u a Z 0 7 V W it Z0 x I! I� 0 < J W u L } y0i Z C I Z W O p a z 0 J p I`I r m t J `tom Z W 1F D 0 M > Z- V < II W 0 m p t O N N QI r 0> a oz kz 0 O < IN MI W U < z O t 7 < 0 W Wm � Q � �.4 j Z 3 n o p W 0 0 t 0 4 ~ m J J J J I n + p e < F k. t U y 2 j O m - a H u » < W t W W W*' J J < l7 W < m G < d W < IL O O tL l Vii. r, S' i J TrVV'L0f V 1 %a r LM III %J I/"1L.A_i_31 IL1I1 \Jt IL-VI\I_OV a W '—S - Permit 't A building permit 'is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and -not to the stove construction. Stove .:` A. New Used B. Typel adia Circulating C. Manufacturer RUSS6 Lab. No. Name/Model No.w 20 RIAL t10• 1513 Collar size D' ensions/Height Length Width ' hlmney A. New Existing RCbINe EX iSf Ia1C f32�C(� CI�If'1/�1Ey B. Size (flue area) C. Other appliances attached to flue (Number and flue size) f13 D. Prefab (Manufacturer—name and type) E. Masonry/Lined Flue liner gyp• 6 manu acturerl Unlined F. Height (refer to diagrams) cap CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction C. Minimum dimensions (refer to diagram) nx Clearances and Wail Protection (see stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE CORNER HEARTH i r WALL. CENTER 12