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Miscellaneous - 784 WINTER STREET 4/30/2018
N° 9680 Pate )' Z- 1�, TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING SSA�MUS� G, This certifies that .. ��r Uf QG! /................ r� has permission to perform .�:. x.A �—o ................... plumbing in the buildings of ........11o,.► ................. at ..... . G�o.� `'�'.... ..... , North Andover, Mass. Fee.40.... Lic. No.�l$ �... ov ....................... PLUMBING INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer t °� 4 � a �� � S �� MASSACHUSETTS UNIFORM APPLICATION FORPERMIT TO PERFORM PLUMBING WORK 1 A -90 A IA CITY MA. DATE / �� f; - 0 % )' PERMIT # JOBSITE ADDRESS .� g �% W ' "' P " 5f OWNER'S NAME YT c -,- F9 /J crk POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL,®.. PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES 1 FLOOR- BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GASIOIUSAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY / ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET / URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which, meets the requirements of MGL Ch. 142. Yes ®, No ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ , OWNER'S INSURANCE WAIVER: l 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 BOX ONLY: OWNER ❑ AGENT ❑ Signature of Owner or Owner's 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME 9 �U V -S e f SIGNATURE LIC # �' 9 Y MP JA JP ❑ CORPORATION Q # a- S PARTNERSHIP E1# LLC ❑ # U �'J S S Ju i AJ WADDRESS: l O &1 kP t-, cls I 0/ COMPANY NAME e i' S CITY ! �� nJ 0 y' 0 STATEI ZIP d/VEMAIL $ eiS rkL ,%>1; 0 11P✓.' Zva b�/Y9e TEL ,! 2 E ' Y 9 - a`// 0 CELL q % /S - 78 6 2 FAX C) 7 ` 6 YI - S- 2 ry The Commonwealth oflMlassachusetts Department of Btdustrial Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j Please Print Legibly Name (Business/Organization4ndividual): Bu r� e$ s h C Address: 6 O f d CJ City/State/Zip:.? yh �? S if o• v- o k4l Phone #: 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 I 6. ❑ New construction employees (full and/orpart-time)* have hiredthe sub -contractors 2.01 am a sole proprietor or partner- listed on the attached sheet. : 7• ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. g, D 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, 9Plumbing repairs or additions myself [No workers' comp, c. 152, § 1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.1] Other comp. insurance required.] !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 aie 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. lam an employer that is providing workers' compensation insurance formy employees Below is thepolicy and job site information. /,� / /J Insurance Company Name:. ! v C �o v \ /7S ne cel Policy # or Sel£-ins. Lic. #: Lu e O to A Expiration Date: Y s' Job Site Address: � FY t ti �ems- 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 o. 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 $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido hereby cert under thepains andpenalfies of perjury that the information provided above is true and correct. Signature: Date: Phone #: 22 g-- b Y s - 'a) 1 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: a 9 0 -P COMMONWEALTH OF MASSACHUSETTS PLUMBER,; AND t' ASFITT-ERS LICENSED AS h, JOURNEYMAN PLUMBE ISSUES THE ABOVE LICENSE TO: MARK W BURGi'SS c 6 -OLD - ...KEN,DALL RD (n TYNGSBORO MA 01879-10213 1 22900 05;61/14 164645 .Comm ON -WEALTH OF MASSACHUSETTS a AND GASFITTERS LIC* NSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: 'Mi PK W BURGESS ('L'D KENDALL RD CD TYNGSBORO MA 01879-1023 11894 05/01/14 164644 u all all COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS REGISTERED AS A PLUMBING CORP ISSUES THE ABOVE LICENSE TO: MARK W BURG -ESS BURGESS PLUMBING & HEATING INC 6 OLD KENDALL RD i7) TYNG890RO MA 01879-1023 2986 05/01/14 164643 `COMMONWEALTH OF MASSACHUSETTS PLI MBER.3 AND A.".31ASFITTERS LICENSED AS k1 JOURNEYMAN PLUM13E ISSUES THE ABOVE LICENSE TO: A MARK W BURGI'-'-)S .6 OLD KENDALL RD TYNGSBORO MA 01819-10231 22900 05., bl/14 ;164645 COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICFN$-ED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: M "i?K. W BURGESS I 6 L'L D KENDALL RD c TYNGSBORO MA 01879-1023 118914 05/01/14 164644 MCI I'll 'COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS REGISTERED AS A PLUMBING CORP ISSUES THE ABOVE LICENSE TO: Ji ,MARK W BURGESS BURGESS PLUMBING & HEATING INC c 6 OLD KENDALL RDi. a TYNGSBORO MA 01879-1023 2986 05/01/14 164643 Date . A 41 z TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... .. ...0 57 9 has permission to perform ..zrexlP A), v wiring in the building of .. r✓ ................................. at ...7i/ .!^ . P :....... .... , rth Andover, Mass. Fee �°� ..... Lic. No 3D�- ..... p ELECTRICAL INSPECTOR Check 11245 Commonwealth of Massachusetts Department of Fire Services M BOARD OF FIRE PREVENTION REGULATIONS Official Use Only f Permit No. I 7 _ Occupancy and Fee Checked �ev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL .INFORMATION) Date: t l + 2 & ' 1 Z 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) 1164 W i 0-Te'Q- S -C Owner or Tenant k i M, Ati)> PAM Fd L t.bp Telephone No. Owner's Address SAM e A5 A eo vO Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building Rei tit A �._ Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters WORK Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: C_u 'k w> �*-i,-E 4 -WV kym-014 Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires (Paddle) No. of Cell: Susp .Fans v Total sformers KVA Trans TTr No. of Luminaire Outlets Z No. of Hot Tubs Generators KVA No. of Luminaires SwimmingPool Above ❑ In- ❑ rnd. rnd. o. o Units Emergency Lighting Batte Units No. of Receptacle Outlets 10 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches � No. of Gas Burners No. of Detection and Initiating Devices Ranges No. of es Ran i No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons ..................... KW I ....................... No. of Self -Contained Detection/Atertina Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Devics or E uivalent No. of WaterKW No. of No. of Data Wiring: 41 Heaters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1,000 . (When required by municipal policy.) Work to Start: j 1- ?Ao i t Z 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: 1NSURA_NCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: & N -53 S Licensee: '8taSiL✓ Signatur . LTC. NO.: (If applicable, enter "exempt" in the license number line) LSM& Tel. No.: -7159 211 �037-'Z Address: 100 M4iw u-slai<tFt SAA 1 &,SO Alt. Tel. No.: 115 L245" 1676 *Per M.G.L c. 147, s. 57-61, s curity 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: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed " on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8—Permit/Date Closed: ***Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: ' Z 12 —3- I Date: ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ]FINAL, INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Com ents: — Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com ,01 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 U www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatidn/Individual): �A,� LL_ Address: MX% t-3 s—c City/State/Zip: GvA. K�Fi c c��� mA. ©tr_w39nPhone #: -761 24S Lb -70 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. E4 I am a sole proprietor or partner- listed on the attached sheet. t 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. ❑ I am a homeowner doing all work right of exemption per MGL mygelf. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] 1 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 91 must also fill 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 submit a new affidavit indicating such. "ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site iformation. isurance Company N olicy # or Self --ins. Lic. Expiration Date: )b Site Address: City/State/Zip: .ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of tvestigations of the DIA for insurance coverage verification. do hereby certify under theme and penalties operjtcry that the information provided above is trice and correct. 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 law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The 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-NIASSAFE .evised 5-26-05 Fax # 617-727-7749 www,mass.gov/dia Date ... ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... �— ......................................................... has permission to perform wiring in the building of ........... ....................................................................... at ...... ........... North Ando er, Mass. North Fe..6-� .... f ..., ......... Lic. No. ...... .... . ...... ... ELECTRICAL INS Check # 9327 JOPA- 1/-- 9/ - It, -;74 S, fm Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 93 3 ,� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ev. 1/07] APPLICATION FOR PERMIT TO PERFORMQeaveblank All work to be performed in accordance with the Massachusetts ElectricalCELECTRICA ELECTRICAL (PLEASE PRINT WINK OR TYPE ALL INFORMATIO527 CMR City or Town of. NORTH ANDOVER Date: e O By this application the undersigned gives notice of his or her intention to perform the eIc electrical wlector of yes described Belo Location (Street & Number) -j w. Owner or Tenant Tj jutltt-r �� Z• S f=/, Cr l.n k3 Owner's Address SA m ( Telephone No. Is this permit in conjunction with a building permit? Purpose of Building i ��.Yes NO (Check A=7�' B Utility Authorization No. Existing Service 00 Amps (ZC,_ j2.s.L0 Volts Overhead Undgrd ❑ No. of Meters New Service �=� Zyp Amps L2a / Volts Overhead Number of Feeders and.Ampacity ® Undgrd ❑ No. of Meters t Location and Nature of Proposed Electrical Work: 5&2v t cc- t` Fac* b0A, ca 2txy� Completion of the followin table may be waived by the Inspector of Wire, No. of Recessed Luminaires N f - of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers No. of water Heaters ICS No. Hydromassage Bathtubs o. o Cell.-ansp. (Paddle) Fans 0. No. of Hot Tubs FNo. EEnersol Above ❑ >n_ d. f Gas Burners No. of Air Cond. °tal eatns ump Number T nsI Totals: - - - Space/Area Heating KW Heating Appliances KW Ballasts of Motors Total HP IN KVA KVA ALARMS JNo. of Zones of Alerting Devices ❑ municipal Connection ❑ Other No. of )Devices or Data Wiring: of Devices or 1 &400 . 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 Lf • ! 21 10 Inspections to be requested in accordance with MEC Rule 10, and upon completion INSURANCE COVERAGE: Unless waived by the owner, no the licensee _provides proof of liabihi Permit for the performance of electrical work may issue unless 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 0 BOND ❑ OTHER ❑ (Specify:) . I certify, under the pains and penalties of PJ er ury' that the information on this application is true and complete - FUM NAME: PP Licensee: ( A J 1 L, s 1-„` Si LIC. NO.: E3 23 3S' (If applicable, enter "exempt " in the license number line.) �$ LIC. NO.: A 13! (, B Address: 100 MA i tiS ,, . (�A �t8aa Tel No.: '10 l ` Z4`t o o3?Z *Per M.G. c. I47, s. 57-61, security work rewires D� tulA C`ily Alt Tel. No.:?<; OWNER'S INSURANCE WAIVER: I am aware that tment of P does noublic t Safety "S ve the License: Lic. No. required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ce co❑ owner'swent. Owner/Agent o Signature Telephone No. PERMIT FEE: $`5�� f The Commonwealth of Massachusetts j ! rt' Department of I.•ndu &hd Accidents Q�ce Ltveni ; � of g ations �` � �� ; 600 N� ashington Street .�_1 Boston, MA 02111 Workers' CWWW-ftWss gov/dia . ompensation Insurance Affidavit: Baiiders/Contractors/Electricians/plam rs Applicant Information • Please Print LeQibl N3nie (Business/Organi..tion/individual): S It Address: V�A, i N ST, City/State/Zip: CUA 4j -----pt 2p ,tA p t L9 b, 0 phone #: t u7Q _ Are you an employer? Check.tbe appropriate box: 1 • ❑ I am a employer with 4. Type of prep (required): ❑ I am a general contractor and I employees (full andlorpnrt-time).* 2. I am .a.sole proprietor ar have hired the sub-cormactors 6 ❑ New constmction listed partner- ship and have no employees ori the attached sheet # 7. ❑ Remodeling These sub -contractors have working far me in �, any capaci [No woticers' comp. insurance Q Demolition workers' comp. insurance. 5. ❑ We are a corporation and its 9 Building addition 3. ❑required-] I am a homeowner doing ofi►cers have exercised their I0•r] Electrical repairs or additions all work rr/yseIf. [No•workers' imp, right of exemption per MGL 11.❑ Plumbing repairs or additions c. 152, § I (4),'and we have no insurance.requimd.] t em l 12.❑ Roof repairs p oyees. [No workers' comp. insurance.required_] I3.❑ Other bad #i must also frill out the section below showing � . t lio*Any apwe n that subcksmit chair workers' isomPe►sat" policy information, t Hameawners who submit this affidavit indicedn they aro nom all d ;Cantnurtars that check this box mustattached an additional sheetsho end then hue outs+de conusctom must submit a new affidavit indi-n* such. wing• the nerve of the Sl1t1.CpTF g .an,- "• rqWd1-- I not an employer that isiang:warkers' informaffon. - -"FJ- poi( ' mmrmarraa. compensation insurance or f �' eP�Y mBelow is tlsePo7'andjghsite Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: ------ Attach a copy of the workers' cootpeusatioa policy declaration page (showing the policy t number and expiration date Failure to secure coverage as required. under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.0p and/or One-year imprisonment, as well as civil penalties in the form of a STOP of up to $250.00 a day against the violator. BeORK ORDER and a fine e 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 parva �iallia of per !WY that the information provided above is true and conva 5i ir.Q•e: l U -------------- Date: � 8 r Phone #: Official use only. Do not write in this area to be coorpleted by. city or town offciaL City or Town: Permit/License # Issuing Authority (circle one): I. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: Location No. %% Date • 9-,42,) pORTH , N Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ � - #? Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL 206`t2 C ),- G' Building Inspee6pr J all O a ':.t'•..� as CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 71(§/7/2007) Date: Sentem�ber 112007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 350 Winthro�Ave MAY BE OCCUPIED AS Retail Liquor Store IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPL, Y. Certificate Issued to: Delta Corp 350 Winthrop Ave North Andover MA 01845 ui ding Insp for e% V�Ilj �o : m c o 0 *' o C.3 C.3 C-1 �Z 2 O A x w W z _ Vz r w w �• m a O�Z S sW •gNA ��„ Cy - A F. dt c *.+ LU C3 CJ C3 � z � o v z0rx u2 w A. o o c .0 cc 5 44 w ro cn cn V�Ilj �o : m c o 0 *' o C.3 C.3 E if caZ N O N C R CD m 07 C O m O CM C 'c N CD fofo O Z 0 J 0 z 0 w w P-4 m U 0 O U 1�-•1 ANON 2 0 Z a O y o c � c cm Ca CD 0— y O O m m CD 0 CD �3 •v as C* Ccm a .n C3 c to C Z CD V y C C C •� C A CA 0 W 0 U) 19 W W ix W U) C-1 �Z 2 O _ m ;CL -0 � m a O�Z S sW •gNA ��„ Cy - A F. dt c *.+ LU C3 CJ C3 a. O� h m� H Z W =am O E if caZ N O N C R CD m 07 C O m O CM C 'c N CD fofo O Z 0 J 0 z 0 w w P-4 m U 0 O U 1�-•1 ANON 2 0 Z a O y o c � c cm Ca CD 0— y O O m m CD 0 CD �3 •v as C* Ccm a .n C3 c to C Z CD V y C C C •� C A CA 0 W 0 U) 19 W W ix W U) Date. ./ 0. - h�.`/L? .Y TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that --� °."'v ..-6A,.1e� Tg ... P.-. * has permission to perform ... t` `4.i `''.V.'�. ................... plumbing in the buildings of ...'Q �U.� ....................... at ... ......l.... ............... . North Andover, Mass. Fee. Lic. No. 012? (... - D.l ()-Z?. (/�`,*I.� PLUMBING 1 PECTOR Check # /5�a 6215 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location _ L/ of New 1:1 Renovation M Replacement FIXTURES TION FOR PERMIT TO DO PLUMBIN Date Permit # Amount Plans Submitted Yes 0 No ❑ (Print or type) //�� l / Check one: Certificate Installing Company Name hfi ,. A% �e // V r ( -f' l7� 11 Corp. Address E]Partner. Business Telephone &Qh)9J1 -7-76r, Firm/Co. Name of Licensed Plumber: l)�n Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond Insura aWaiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above thre in ign` re Owner 11re I h eby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbingd � d C.?"r!`i`�V� of the General Laws. Type of Plumbing Lice#'e c se um er �� Master OVED (OFFICE USE ONLY . Journeyman 0 Date../ ...u. 4� ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �' .t......................................................................................... has permission to perform........................................................... wiring in the building of ....... at..... f `.. ................................. �-- .;1 , Nort Andover, Mass. Al3ysb... Fe`s ..................... Lic. No.............. ........... ....... ......... '� ELECTRICAL PECTOR Check # 5544 0' s 1 Q -.- -- =-- 1 tie c, ommonweaan o1 Massa husetts (` Permit %o. �v Department of Public Saf Uccupancy S Fee Checked �: � BOARD OF FIRE PREVENTION REGULA NS S27 CMR 1200 3/90 t)eave blank) APPLICATION FOR PER IT PERFORM ELECTRICAL WORK All rwrk to be performed In accord n<e ' h the Massachusetts Electrical Code. 5`27 CMR 12:00 (PLEASE PRINT IN I2iR 0 ALL R4MON) Date ( "� �— 0 , City or Town of , /% V To the Inspector of Wires: The undersigned aoolies for a z ---w -_, E_rlgtt the electrical work described below. Location (Stree O6mer or Tenant Owner's Address S #M Lr Is this permit in conjunction wit a b�uiil�dinngO permit: Yes IN No ❑ (Check Appropriate Box) Purpose of Building ' ' / ` l��i�'/�" Utility Authorization NO. / Existing Service Amps { / J �V Volts Overhead Undgrd ❑ No. of Miters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters N=t>er of Feeders and Ampacity, ^_ Location and Nature of Proposed Electrical Work L-)114-o� rG6W I&M nld �1 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures No. Above In - Swimming Pool grnd. ❑ grnd. ❑ _ Generators ICJA No. of Receptacle Outlecs No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets L No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local 1:1 Municipal ❑Other Connection No. of Ranges Total No. of Air Cond. tons No. of Disposals Heat Total Total Tons KW No. of No. of Dishwashers Space/Area Heating Kai No. of Dryers (Heating Devices KW No. of Water Heaters KW No. of Signs Ballasts Wtrinoltage No. Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YESC] NO C] I have submitted valid proof of same to this office. YES ❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE P BOND ❑ OTHER 17 (Please Specify) — 6s-- Expiration Date) Estimated Value of Electrical Work S /d—)(-6 Work to Start Q _Q Inspection Date Requested: Rough /Q 1 / — d Final Signed unde t e peena�lt:ies of perjury: FIRM NAME I�LLIC. NO. A J Y Licensee /-/v Cm/�C, J1A Signature Address OWNIER'S stantia applica Telephone No. Signature of Owner or Agent not have the insurance cdverige or its 'and that my signature on this permit ease check one) PERMIT FEE S J, G 0 This certifies that Date 7:..`!� e-.-, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform .... P. V .. ........................... plumbing in the buildings of ....r �......................... at ....% .`.� .. . .. ............... North Andover, Mass. Fee.. .... Lic. No... % ) ? ............. P LIMBING INSPECTOR Check # 5705 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (PrintorType) V , Mass. Date Permit #?>� Building Locationekm Owner's Nam Type of Occupancyt'51 17 E �j New ❑ Renovation ❑ Replacement Imo' Plans Submitted: d"s U No ❑ 1—W FIXTURES � Installing. Company Name AOMe—T A • L tO al M#4TAe--0 Check one: Certificate Address 'j-, ) ❑ Corporation lY) E TK U C --A) YO A 0 t s� / ❑ Partnership Business Telephone 517'7 d 9 /Co. Name of Licensed Plumber 'r OM3F;27- ftl �A,vld►1,�i �Kl�r" INSURANCE COVERAGE: I have a curregjiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ' If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy 21/Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: 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 under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum • g Oode andrr7 of the eral Laws. By j T.til: U Viiffire of Licensed Plumber Title Type of License: Master Journeyman ❑ Qty/Town APPROVED (OFFICE USE ONLY) License Number V 5 • Y • • • • • Installing. Company Name AOMe—T A • L tO al M#4TAe--0 Check one: Certificate Address 'j-, ) ❑ Corporation lY) E TK U C --A) YO A 0 t s� / ❑ Partnership Business Telephone 517'7 d 9 /Co. Name of Licensed Plumber 'r OM3F;27- ftl �A,vld►1,�i �Kl�r" INSURANCE COVERAGE: I have a curregjiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ' If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy 21/Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: 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 under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum • g Oode andrr7 of the eral Laws. By j T.til: U Viiffire of Licensed Plumber Title Type of License: Master Journeyman ❑ Qty/Town APPROVED (OFFICE USE ONLY) License Number V 5 y ' A -1 ' O Z v m f gE In O 23 O In m A m C N m O z E; m .r' A O z c A z m o 3 •1 -4 W O v O m r c c La z A r z O � m C v � r c z z v 0 z to v .► m m A I 9 v m f gE In O 23 O In m A m C N m O z E; m .r' A O z O z m o 3 •1 -4 O v O r c c La z A r v m f gE In O 23 O In m A m C N m O z E; w J/- Location %f I s _ No. 173 Date TOWN OF NORTH ANDOVER F w p a y + ; , Certificate of Occupancy $ Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Check # 97 /5 17634 Other Permit Fee TOTAL Building lnsp6cyor 35 Ari, TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 't BUILDING PERMIT NUMBER: y DATE ISSUED: SIGNATURE: Building Commissionef/IngActor of Buildings Date (LlTiA1i ['.iTT � v Vl\ l-.JllL' L\1'Vl�l\1M 11V1\ { 1.1 PropertyAddresss: O -I V�11V (ff 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide ReqWred Provided R redProvided 1.7 Water Snpp M.G.L.C.40. S4) 1.5. Public Private ❑ Zone (�T /\TiA1T A Flood Zone Information: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: / ❑ On Site Disposal System Z7 - •..-. �.�+�..� ::..,a a•a.aa v\. a.a:.awaau .efv laaVllv.n•L HVEl\1 ..-•••••• •.••'••��• � �•� ivv 2.1 Owner of Record --rIM o rMl �n� �Q<�- a l t'wl qYY GJ.yv rte 577 2£7" Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Pant Address for Service: r a-e�Q q�a-G3 - 8y9D Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone 3.2 Registered Honim-Improvement Contractor IMV )%/A.AAA,1 -] ✓i Address - 314= Not Applicable ❑ 03Urg6 _ License Number Expiration Date Not Applicable ❑ i2-7fg0 Registration Number Expiration Date rL 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 .......0 No ....... 0 SECTION 5 Oestri tion of Proposed Work check aU a cable New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. 0 Demolition 0 Other ❑ Specify ' Brief Description of Proposed Work: Pc*"Je'l Z�nof -&01 b6}hm0IM�)2 �a�l . I ionl 64"It, wo" 1 nd 00C Wd SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building +y� U �X (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of/ Construction 8 D �. 3 Plumbing O o p , O® Building Permit fee (a) X (b) � a O `- 4 Mechanical HVAC O 5 Fire Protection -0- 0- 6 Total (1+2+3+4+5 6 Check Number d SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 1 A4 0 II/Y I-. F I'l ow as Owner/Aut4erize4,4gt of subject property Hereby authorize `-jU ^ �i to act on My beha ' i al � rel work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNERAGENT DECLARATION �/A "'UTHORIZED I, "Tot%AJ. ; as 4rw=/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 Si ature of Owner/Agent//1'11 '11Date NO. OF STORIES JSIZE BASEMENT OR SLAB SIZE OF FLOOR TIIIIBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 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 disposed of in: o (Location of Fac k 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 i CAA46}N.. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: Citv Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity EiI am an employer providing workers' compensation for my employees working on this job. Company name: 1�'�"` G� x'111 Addrpms ©L 3 (3 Phone # �- Poiicv # \, ;J Ce --)o -7 q Z95-7 2:Z6 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 and/or one years' impriso ent_as weti_as_civil_penakiesinthefmn-cf a..ST.OP.WORK..ORDER..and_a.fine d ($100.00)-a day against me. I understand that a copny of t r statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certi> i u , 4 �A-ns and penalties of perjury that the information provided above is true and correct. Print Official use only U \,/ do not write in this area to be completed by city or town official' L"t1(3 # JTZ - 3-74 - r-2SZ. City or Town Permit/Licensino ❑ Building Dept ❑Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person: Phone #. [ Health Department ci Other Town of North Andover Building Department 27 Charles Street ' North Andover, MA. 01845 A"°'""`5 1SSwtt5�� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542. Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map / lot "HOMEOWNER Name Home Phone PRESENT MAILING ADDRESS, City Town State Work Phone The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Zip Code Specifcations--Bath remodel 2nd floor Pam Fallon 784 Winter St., No. Andover MA 01845 1. Replace existing bathroom shower & water closet(toilet), remove existing flooring and subflooring. Remove existing ceiling and, install new moisture resistant sheetrock, tape and joint compound and prime or blueboard & plaster. Save all existing trim, mouldings and jamb . 2. Electrical--Install new fan light and new GFI circuit. Vent fan through ceiling and roof.)' 3. Plumbing--Install rough plumbing and finish for the following. -Install new strip of baseboard heat.I -Aker corner shower unit. \�I�-Maasfield water closet with seat is � -Install new double sink & two faucets 4. Install new Aristokraft bathroom vanity with Swanstone top. (owner to choose) Allowance for top $500.00, allowance for vanity $500.00. Installation of top & vanity $300.00 5. Install new 3/8" AC underlayment. Tile allowance is $4.50 per sq.ft. 6. Owner to supply all finish painting. 9 ' I i�0 a d G � 5 y 'yt 1 .o R � IIU 0-1 `�''� Ck Pam Fallon 784 Winter St., No. Andover MA 01845 Specifications --Bath remodel 1 st floor 1. Replace existing vanity & water closet(toilet), remove existing flooring and subflooring. Save all existing trim, mouldings and jambs. 2. Plumbing --Install rough plumbing and finish for the following. -Install new strip of baseboard heat. c ►I���-Man-sfield-water closet with seat. -Install new pedestal sink and faucet. 3. Install new 3/8" AC underlayment. Tile allowance is $4.50 per sq.ft. 4.-+nstali-new-f4us-h-medic-ine--caNnet; allowance-$4W.00;jmt.-a ea=$50.00. 5. Electrical. Install GFCI in bathroom. 6. Owner to supply all finish painting. VV l.J Lo � �Q_14,j Specifications --Tile floor in foyer l 1. Remove existing tile. Install new 3/8" AC underlayment. Tile allowance is $4.50 per sq.ft. l Save all existing trim, mouldings and jambs. ,aj_rj`� v` Home Energy, Inc. Building Contract This contract, dated May 17, 2004 , is by and between the following owner and contractor. Owner: Tim & Pam Fallon Telephone: Home978-687-8490 Work 617-662-2871 Mailing Address: 784 Winter St., No. Andover MA 01845 Contractor: Home Energy, Inc., 14 Edgehill Rd., Haverhill, MA 01830 MA Home Improvement Contractor license certificate #127191 Fed. I.D. #04-3355584 Telephone: 978-374-6256 1. GENERAL This contract is for the following work and materials to be performed by the contractor on the property address above. The project is generally described as follows: Specifcations--Bath remodel 2nd floor 1. Replace existing bathroom shower & water closet(toilet), remove existing flooring and subflooring. Remove existing ceiling , install new moisture resistant sheetrock, tape and joint compound and prime or blueboard & plaster. Save all existing trim, mouldings and jambs. 2. Electrical --Install new fan light and new GFI circuit. Vent fan through ceiling and roof. Install two new wall fixtures and replace one ceiling fixture. 3. Plumbing --Install rough plumbing and finish for the following. Proposal attached. -Install new strip of baseboard heat. -Install Sterling neo angle shower unit. -Kohler 3452 water closet with seat -Install new double sink & two faucets 4. Install new Merrilat bathroom vanity, Lariat maple toffee deluxe VBD60 with Swanstone double bowl top, Tahaiti sand. Install Merrilat cabinet over toilet, VS2430. Allowance for top $829.00, allowance for vanity $811.00. 5. Install new 3/8" AC underlayment. Install new tile floor. Tile allowance is $4.50 per sq.ft. 6. Hang new mirror. 7. recapture attic space adjacent to bathroom. 8. Owner to supply all finish painting. Specifications --Bath remodel 1 st floor 1. Replace existing vanity & water closet(toilet), remove existing flooring and subflooring. Save all existing trim, mouldings and jambs. Install new wainscoating to 40" high in bathroom 2. Plumbing --Install rough plumbing and finish for the following. Proposal attached. -Install new strip of baseboard heat. -Install new Kohler water closet with seat. -Install new St. Thomas pedestal sink and faucet. 3. Install new 3/8" AC underlayment. Install new tile floor. Tile allowance is $4.50 per sq.ft. 4. Remove shhetrock on plumbing wall & replace. 5. Electrical. Install GFCI in bathroom. Replace existing light fixture. 6. Owner to supply all finish painting. Specifications --Tile floor in foyer 1. Remove existing tile. Install new 3/8" AC underlayment. Install new tile floor. Tile allowance is $4.50 per sq.ft. Save all existing trim, mouldings and jambs. 1. The contract consists of this document, any plans or specifications or exhibits referenced herein, and the General Conditions following the signature page. Change orders and modifications shall be in writing and shall become part of this contract. 2. PRICE The total price for the work agreed upon is $21,546.41. Payment terms are set out below, in Paragraph 6. 3. STARTING AND COMPLETION PROVISIONS The work will begin on September 7, 2004 , and will be completed, absent unusual circumstances, on October 5, 2004. 4. PERMITS AND APPLICABLE CODES; COMPLIANCE WITH LOCAL LAW a. All work to be done under this contract will be in accordance with the building codes presently in force in the Town of No. Andover, MA. The contractor shall obtain all necessary permits and pay all required permit and plan fees. b. The contractor shall at all times comply with the laws of this,state regarding mechanic's liens. 5. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP This contract will be completed by the contractor in a good and workmanlike manner, using good quality materials. The parties agree upon the following materials specifications and work description, together with any plans or specifications incorporated herein. 6. PAYMENT a. Timely payment by the owner of all sums due under this contract is of the essence to this contract. The parties agree to the following schedule of payments: PAYMENT SCHEDULE DATE EXPECTED AMOUNT cabinet & fixture deposit 6/01/04 $4000.00 demo 9/07/04 $4000.00 rough elec.& plumb. 9/14/04 $4000.00 framing & sheetrock 9/21/04 $3000.00 flooring 9/28/04 $3000.00 finish elec. & plumb. 10/01/04 $3000.00 occupancy permit 10/05/04 :',E 0 6. `L I I a I I EOG.'f( The contractor shall provide the owner with his own waiver or cumulative subcontractor's waivers equal to the amount paid for any progress payment. b. The contractor may cease operations if any progress payment is not made by the owner as required herein, and proceed to collect any balance due with any legal remedy. Alternatively, the contractor may continue operations, as set forth in the attached General Conditions. 7. SIGNATURE Attached hereto are General Conditions governing the rights and obligations of the parties to thi! contract. The parties are further subject to the laws of this state governing contracts and mechanics' liens. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. IN WITNESS WHEREOF, we have hereunto set our hands and seals this 15 r day of 2004 . owner V contractor GENERAL CONDITI These General Conditions are part of the contract betweerTim & Pam Fallon and Home Energy, Inc. for work at 784 Winter St., No. Andover MA 1. CONTRACTOR'S DUTIES -GENERAL a. To direct and control the work contracted for in accordance with the terms of this contrac and all applicable codes, laws, and regulations, and as the building permits, if any, issued for this project require. b. To inspect the site, examine the plans and specifications, if any, and supervise all of contractor's employees, and to direct the work of all subcontractors selected by contractor. c. To maintain the work site in a safe and clean condition, to the extent consistent with the contract. d. To advise the.owner promptly if concealed conditions are ascertained which require additional or different work, and to proceed in such event in accordance with this agreement. 2. OWNER'S DUTIES -GENERAL a. To provide adequate utilities for the work agreed upon. b. To advise the contractor of any condition of the property which affects contractor's ability tc perform. c. To provide secure storage areas for materials delivered to the work site. d. To execute in a timely manner all permit applications and other documents necessary for the work to proceed. e. To perform no work on the project without a written agreement with the contractor. f. To avoid interfering with workers. g. To make no agreements with any tradesperson, subcontractor, or contractor's employee outside the scope of this contract without the written consent of the contractor. h. Owner shall be entitled to make periodic inspections of the work site when accompanied by representative of the contractor, provided such inspections do not interfere with the work and can, in the sole judgment of the contractor, be made safely. Any other entry onto thr, construction site shall be at owner's risk. 6. MATERIAL SUBSTITUTION Contractor reserves the right to substitute other materials, products and/or labor, of similar, equal or superior quality, utility, or color. The Contractor reserves the right to make alterations to the heating and/or cooling system, provided any such substitution or alteration has comparable durability and performance characteristics. In the event of the substitution of any appliance or heating equipment, the warranty terms of the substituted materials shall be equal to those originally specified unless the owner otherwise agrees in writing. 7. DELAY Contractor shall not be responsible for delays caused by events beyond the control of the contractor, including but not limited to: strikes, war, acts of God, riots, governmental regulations aned restrictions. Delays caused by owner's failure to make allowance materials' selections or caused by the performance by contractor of extras or necessary work (as described in Paragraph 9) shall likewise be excusable delays. 8. INSURANCE Contractor agrees to maintain all necessary forms of insurance to protect the owner from liability for any occurence arising from the performance of this contract. Contractor agrees that he shall cover his own employees for worker's compensation and carry general liability, and that all forms of insurance carried hereunder shall be with reputable companies licensed to do business in this state. Owner agrees to carry full coverage on the subject property covering owner's risk of loss during the construction period, together with all special forms required by reason of the performance of this contract. 9. HIDDEN, CONCEALED and UNFORESEEABLE CONDITIONS The parties agree that in the event contractor discovers a condition requiring an extra cost that they shall proceed as follows: The contractor shall notify the owner verbally at once to expedite agreement as to the charge to correct or cure such condition, and provide a written estimate a soon as practicable. The parties must agree to such extra charges, or agree to a resolution method, or this contract may be canceled by either of them. For purposes of this section, a "hidden, concealed and unforeseeable condition" shall mean a condition not readily observable to a prudent contractor inspecting the subject property for the purpose of performing this contract. 10. EXTRAS Any extra work or materials desired by the owner shall be agreed upon in writing and such extras shall become a part of this contract. Unless otherwise agreed, extras shall be paid for as performed. Failure of the owner to sign an extras order shall not preclude recovery for same by contractor, and acceptance of said extra work or materials shall be presumed, unless there is written notice to the contrary. Contractor shall advise owner at the time of agreement on an extra as to any additional tim required to perform this contract. 11. SUBCONTRACTORS a. Contractor shall select subcontractors as required to complete this contract. Owner acknowledges that various portions of the work will be done by subcontractors. Any subcontractor selected by the contractor shall have all requisite licenses for the work to be done by such subcontractor, and the contractor shall issue subcontracts in writing whose specifications are consistent with this agreement. b. It shall be the duty of the contractor to use reasonable care in the selection of subcontractors Absent objectionable performance by any subcontractor, the selection of subcontractors shall be with the contractor exclusively. The contractor shall require all subcontractors to have such types of insurance in force as are required to hold harmless and indemnify the owner from any claim for injuries or property damage by any agent or employee of any subcontractor. c. Contractor shall pay subcontractors on a timely basis and obtain from subcontractors any necessary, documentation required to release their lien rights, if any, as the work proceeds. d. Contractor shall exercise reasonable care in the selection of materials used by subcontractors, but shall not be responsible for later discovered materials' defects or damages from installation methods, not reasonably ascertainable at the time of installation. e. All home improvement contractors and subcontractors shall be registered: Any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108, Tel. (617)727-8598. 12. TERMINATION and CANCELLATION The contractor may terminate and cancel this contract if any payment called for hereunder is not received as scheduled, provided that notice is given to the owner as provided below. Upo such termination, the contractor shall have all remedies provided by law, including such lien rights as then apply. The owner may terminate this contract upon the following conditions: a. Failure of the contractor, or his subcontractors, to pursue the work contracted for, -absent excusable delay, as provided in Paragraph 7 above, for a continuous period of seven days, without a written agreement permitting same, which may be satisfied by a simple notation to this agreement. b. Failure of the contractor to rectify any condition regarding which building code enforcement authority has issued a citation or violation notice, within seven days' notice of such violation, unless owner and contractor otherwise agree. c. Any other failure to perform this contract required by the terms of this contract. d. No termination shall be effective unless 10 days notice of owner's intent are given as provided below, during which time the default may be cured by the contractor. 13. WARRANTIES a. The work of the contractor including materials and labor, shall be guaranteed for a period of five years, during which period contractor shall at its own expense correct any defect arising from its work unless Paragraph 11 (d) of these General Conditions applies. This provision is in lieu of all other warranties, express or implied, and owner has no action at law or in equity against the contractor after said date . b. Any and all warranties for appliances or mechanical systems shall be delivered to owner when contractor's final payment is received. c. Notwithstanding any manufacturer's warranty of any component, appliance, or system, no action may be brought against the contractor on this contract, for the performance of this work, except as provided above. 14. NOTICES Notices may be sent to either party at the addresses shown above, or mailed by certified or registered mail. Any mailed notice shall be deemed given as of the date of mailing. 15. SEVERABILITY If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall remain in force between the parties. 16. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the consumer shall be req ired bmit to such arbitration as provided in MGL. c. 142A. Owner--- -----Contractor NOTICE: The signature of the parties above apply onl to the greement of the parties to alternate dispute resolution initiated by the contract r. T o ner may initiate alternative dispute resolution even where this section is not sign d se ra ely by the parties. 16. ENTIRE AGREEMENT This contract consists of the documents defined above, and co titutes the entire agreement the parties. It can be modified only by a written docum nt. I ITNESS HEREOF, we have hereunto set our hands and seals this da AR 2004 , at Owner__N____________ _ Contractor �_ ✓� , BOARD OF BUILDING REGULATIONS I License: CONSTRUCTION SUPERVISOR i Number: CS 036866 I ' Birthdate: 03/25/1956 Expires: 03/25/2006 Tr. no: 22781 Restricted: 00 JOHN J CALL I 14 EDGEHILL RD 01830 Actin4Cm *90neri HAVERHILL, MA per'' Alae �amircazu�ea a�,_/%�aoac/auael�a �-\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:. 127191 Expiration: 9/17/2004 Type: Private Corporation HOME ENERGY, INC JOHN CALL 14 EDGEHILL RD HAVERHILL, MA 01830 Administrator c 0 z I W W tv L c O y O O : C1 V 41r. CD :mc 0.P: Ea CF 0 ~L iEc ?: • 0 s �mcm�E C mmMm M iA y O cm m y m VJ m E ocm av b.: m V1 m m : _.. O cmc ' 0 � c 1 � 0 .� c m 46 m �Z 0 r! cmc c CL CL m�� m GO WO .0 C +� •yfO CL O C Z �� W 'E �, cmi o, o C'+* a 5 O P = 2o.. -m S M a 0 NNB' E c z D y h E O v cc CL Cos O C. COD C O !O c C. h cm a� C. 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