HomeMy WebLinkAboutMiscellaneous - 80 ADAMS AVENUE 4/30/2018North Andover Board of Assessors Public Access f NOR4p Ss+oc� Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial -, 0 Page 1 of 1 North Andover Board of Assessors roperty Record Card Location: 80 ADAMS AVENUE Owner Name: MARRION, RUTH, M Owner Address: 80 ADAMS AVENUE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 5 - 5 Land Area: 0.19 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 816 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 278,200 260,200 Building Value: 122,000 101,200 Land Value: 1.56,200 159,000 Market Land Value: 156,200 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2253042&town—NandoverPubAcc 3/19/2013 M O N LL w m Z W Q N Q p Q 0 ao w UOf U o o � ¢ W U o¢ a a � O O O a O O aF- 0 J O M O O Y U O J ED 0 Lf) IV 0 Q 0 o rr� r IH' o 0 0 0 OOH. } N lo NO N N U lea ONS- oo'X�U' k d I;a N J C'9I. p 0 J J m� o -0it, ; m d ; ii(.i COO Y Y Z. 0 o'n' U) > r Q V)lm O. 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W}(7Uao LL Z Z LLJO L6 v.-� o�� Q Ln O rr o a"co ~Lr) W Q: x I c6 LL co R p 'S WEE �Ms � �y L m coU O a°N o;0mm.f60c(9.o m Q w L =(� Z M w rL O N 3 f6 C 76 V X 'u) (nn..� ':mca< HmLL=wmYw ry LU H w> ZI an m V L) m Qp LL Vr�moat Q CL z y Z Q r 6ad hiU co r 2 �¢ Sao �_ �: ~~'0 @ o w 3: o`0 0 mmoc: 0 o iC O N 0 .2 0 O Y ()(nawLL =L.LLLU a cn co co 0 0 0 0 0 0 0 0 0 q Lo 0 CD N TOWN OF NORTH ANDOVER PLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: (_ Ta4r.-:�r' - IMPORTANT: Applicant must complete all items on this pate LOCATION 80 A-OANIS RyE Print PROPERTY OWNERtAfA tJ _ --- [� Print 100 Year Old Structure yesC,,,n MAP NO: �7 PARCEL: ZONING DISTRICT: Historic District yes Machine Shoo Villaae v e s TYPE OF IMPROVEMENT PROPOSED USE ResiqIential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ 6 Lteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic E] Well � Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: SiKln oms"Rczf Identification Please Type or Print Clearly) OWNER: Name: Ru.th MpiPymom Phone:OM-6ig- nZ5 Address: 133 R®Pm CONTRACTOR Name: NARHN)o C,onSiTLy_k on Phone: SoB- 3-n - Z/4wl Address: iZz SnA-,noG S�-__ _. Supervisor's Construction License:_(°S-0-13183 .Exp. Date: Home Improvement License: 2n_? Exp. Date: -5-13111S- ARCH ITECT/ENGI NEER /3/f/S- ARCHITECT/ENGINEER Phone: /_T'['rn-7; Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ (I e Z7/ , i 8 FEE: $ I SU Check No.: Receipt No.:Q'O-D�� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of _A ent/Owner Y Sig atu`re of contractor ,� ! Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location 0 A 4 �P--- No. ' Date Check #�&� TOWN OF NORTH ANDOVER Certificate of Occupancy $ :iss�Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ t' TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF'SEWERAGE DISPOSAL 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 ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Conservation Decisio Comm Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tovvo Engineer: Signature: Located 384 Osgood Street FIRE DEPA RTMENT - Temp Dumpster on site yes no Located at 124 Mair, Street - -Fire Departinerit•signature/date" COMMENTS LL O z m v uo Y 'D O O LL N C2 (U N 00 b Z' c� Z o c 1 co 7 O LL O = a v C EbO L U N O LL u W z m J O. L O O K M C 11 0 W Z a u F W W L j O CC V ` N (A _ m = LL O a z ,n L j O K f0 LL z W 4: Q W 0 ui 25 LL N 7 CO O Z Y �, N v 0 d Y E N n O ca O Cc O V W n Q Cc d y cc : z � E * 0 •= o CL Co •v W yOa J= E 2 f u O Q• L =' Q 62 a Z 1p „f** Q Co U) 4 m c Z 4) r :a Cl) `cm Lu o N / c ; 'F' v—^^ 'y4)Q = xz +�tt G W O foo � �c� �cz m N C C/) ion '> c W J c H d z rL 5 as�w m w o .r ICD o c _ P Q L ic0 :5 O 2 m 0. a) .5N O rn c7 m CO) m ® W C '04- O O CL 0 R Ln c O .� .r r O z W � N V 'O C V L v N._ ` H �j• (� d O -0 d 2 <C�. C O 1— L a0+ m O V 5 ZE w d O Eo O z O � I CA •E W 0- H O �+ V 0 L cc O Q a CL �Q o� Cc VJ '0 0-0 O ) w � O 0 u) c _ CO) B The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual):tJ(l},AWW CorGAr,,,c.};otN Co Address: /77 ScN mL s� City/State/Zip:o�, MA M072 Phone#: S'og-3Z8-gw I Are you an employer? Check the appropriate box: 1. L 1 am a employer 4. ❑ I am a general contractor and I Type of project (required): ` with —� 6. New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. # �• Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition workingfor me in an capacity. Y p t3'• workers' comp. insurance. 9. EJ Building addition [No workers' comp. insurance 5. ElWe are a corporation and its 10. ❑ Electrical repairs or additions required.] 3111 am a homeowner doing all work officers have exercised their right of exemption per MGL 11. ❑ P bing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12. oofrepairs insurance required.] i employees. [No workers' 13. ❑ 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 a're doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. M n Lcol m A n D FM SO iu S Policy # or Self -ins. Lic. #: L-039-0101467 Expiration Date: &-/S-/ y Job Site Address: 10 RDAM S Ave City/State/Zip: Nav+6 - nDeae r, MA 01 `SII S' 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 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. Y do hereby ertr under the pal d penalties ofperjury that the information provided above is true and correct. Sianatur . Q,yt - 0( & lyb� Date: 61 4 I 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 Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone ACRD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYYyy) THIS CERTIFICATEIS ISSUED AS A TIVELY OR NEGATIVELY AMMATTER OF INFORMATION ONLY AND GpNFERS NO RIGWTS UPON THE CERTIFICATE H()LDER. THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES CERTIFICATE DOES NOT AFFIRMAEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESR. 1z013 NOT CONSTITUTE A CONTRACT BE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. TWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Malcolm & Parsons Ins. Agcy, Inc, NAME: 6 Freeman St. PHONE AIC�No E, tl: 781.344.3200 P.O. Box 527 EMAIL (a�c Nei ►81.344.1425 ADDRESS: Stoughton, MA 02072 _ INSURER(S)AFFORDING COVERAGE INSURED Naranjo Construction, Inc _ INSURERA: AtlantlC Casualty Insurance (:Q 42846 # 122 School Street INSURER B; Hanover Insurance Stoughton, MA 02072-2319 INSURERC; 222 2 INSURER D: ------- _ INSURER E: COVERAGES INSURE THIS IS TO CERTIFY THAT TWE POLIC ES OFI INSURATE NCE MB ER EapW HA 6E BEENl SSUED TO THE INSURED NAMED ABOVE FOR INDICATED. NOTWITHSTANDING ANY REC PERTAIN, THE' TERMOR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT '' ' 1ITHJ FORA PO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE ITERMSIOD EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, I LTR TYPE OF INSURANCE GENERAL LIABILITY INSR WVD POLICY NUMBER - _ MMI DDIYYYY MM/DD/YYYY L035-010467 06/15/2013 06/15/2014 LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 I� ,000,00( CLAIMS -MADE ® OCCUR PREMISES (Ea occurrence) $ 100 00C A � fMED EXP (Any ore Person_) $ 5,00C _ PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT I APPLIES PER: GENERAL AGGREGATE � X POLICY( PRO- $ _ 2,— 0 00,000 JECT LOC PRODUCTS - COMP/OPAGG _–_ AUTOMOBILE LIABILITY 21000,000 AMN-2318565-05112/07/2012 12/07/2013 (Ea 'ocident) ANALLY AUTO I B PX1 FlUTOS NEO X SCHEDULED I BODILY INJURY (Per person) $ AUTOS 100, 000 HIRED AUTOS X NON -OWNED OSI BODILY INJURY {Per accidanl) $ r---� —. 3�0, O0Cf UMBRELLALIq–gPer accident $ 100,000 i�� EXCESS LIAR OCCUR $ CLAIMS -MADE I I EACH OCCURRENCE $ _ DED REE NT1 N$ AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS' LIABILIT $ OFFIC OPR I TOR/PR/EXECUTIVr[N TORY LIMITS ER BER EXCLUDED? IL�JI N/q _(MandatoryinNH) I I E. L EACH ACCIDENT $ If yes, describe under DESCRIPT(ON OF OPERATIONS below E.L. DISEASE • EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ ESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addittanat Remarks Schedule, if more space Is required) !neral Carpentry, remodeling & roofing for residential dwellings, 1s-beenCompensation, w/ Liberty Mutual policy-#WC2-31S=381'573=013 eff 4'/30/2®13-4/13/2014, certificate Cs been requested`froln the carrier, as r_equir-ed_,b MA_state -. law, _and will be forwarded ._- ERTIFICATE HOLDER �--- - - - _ - u pon-recei tp .( CANCELLATION J FAUTHORIZED HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR2 ATE THEREOF, NOTICE WILL BE DELIVERED IN H THE POLICY PROVISIONS. SENTATIVE In ured COPY / Evidence of Insurance Amne Parsons ©1988-2010ACORD CORPOR TION. All ric;hts reserved. ,ORD 25 (2010105) The ACORD name and logo are registered marks of ACORD P CL Z2 CL ro 0 Doi,, W CD Ll < < Z Lr) 000 0 0 �— m <-Wz) 0 <<N�— VCL C: iD Sll -05 coo :'tI, P CL Z2 CL ro 0 Doi,, W CD Ll < < Z 0 000 0 0 �— ),— Z < <-Wz) 0 <<N�— P CL Z2 CL 10 PSu Par Plaz , - �- --- itc 5 170 Boston) M".a5sac13u.setts 02116 ome jjpprovruj�, ontractor Regist'r9a, - Z, NARANJO CONSTRUCTI JASNAANY NARANJO 18r STATION ST STOUGHT ON, MA 02072 ...... ......... ... . .. 44_1 (mice of Corsm , ncs Rs OME IMPROVEMEN NT Registration* 9 ,7 Expirafr6' D'I ,WRANJO 187 STATION ST S-FOUGHTON , MA 6107 169209 Supplement Card FXpiration: 5131/2D13 Update Address and retlim Md. M2rk reasD for change. 'x ddress Lost Cay Employmellf ... .. . ....... .. ............. valid for individul use OrlY n ess Re.g 131 �i 1i 0 n 1'icemse oz 'v " fo bc,forc,. Ott expiration d - If found return to: found XTOR Office of Consumer Affair, nd Business ReguNtion Type; Suite 5170 10 Park flM - Suite 5170 16 stippIplijent Card Buq'm. MA 0'21\ INC. of 0. a et Ij i Conw"cowl SU pc vvj.'j(� F, JASMANY, G DkiANJO 187 STATIONST STOUGM,'(W mA 0511012014 11111 111 1 1 111 111 Job Number: 16021076 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 4-6 WEEKS (Approximate Start Date) It will be substantially completed by approximately 4-6 WEEKS (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc. ("Sears") or at any other time by mutual written agreement. Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials ("ACMs") that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work, then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty (30) days, Sears may cancel this contract upon Customer(s) initials written notice to Customer. The TOTAL PRICE including all labor, material, taxes and any applicable discount is $ 11,271.18 Contract Price $11, 271.18 Initial Payment (not to exceed 30% of Total Price unless Special Order) $ 3,381.35 State Sales Tax ( 0.00 %) $ 0.00 Final Payment (balance payable upon completion of job) $ 7,889.83 Local Sales Tax ( 0.00 %) $ 0.00 The Initial Payment is due prior to Sears ordering products. I Total Amount Due $11, 271.18 The form and method by which the Customer(s) will pay is described in a separate Cash/Credit Card Payment Addendum made a part of and incorporated into this contract by reference. Customer(s) initials 1 11 NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER) AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and Approval. Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown. This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale, it must be approved by the Credit Sales Department. If this proposal is not approved or the installation cannot be made in accordance with the law, this offer will be withdrawn and any payments you have made will be refunded to you. Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation. Sears is not responsible for materials or installation NOT furnished or arranged by Sears. Sears' installation contractor(s) will obtain all building permits required by local law. For homes located in historic or landmark zoning districts, Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1) arrange for a contractor (licensed where required by law) to make the installation of materials; (2) issue a work order for this installation to a contractor; (3) inspect the installation; and (4) pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation. I agree that Sears is not responsible for delays in delivery or installation due to weather, fire, strikes, war, government regulations or any causes beyond Sears' control. Oral Agreements and Changes in Contract. I understand that there are no oral agreements between Sears and me. Everything I expect Sears to do has been included in writing in this contract. Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Buyer. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical & Plumbing Service. I will provide adequate electrical and/or plumbing service(s) to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s) do not meet the standards of the utility company or electrical and/or plumbing codes, I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment. I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information. Appropriate product warranty documents will be given to me by Sears. Sears' Warranty on Installation is: SEARS' LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s) used (which warranty becomes effective the date the merchandise is installed), if the workmanship (or application) of any Sears' arranged installation proves faulty within five years (Best), three years (Better), two years (Good) or one year (Limited) after products are installed, then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you. If Sears determines that repair is not commercially practicable or cannot be timely made then, at Sears' sole discretion, Sears may elect to provide replacement or refund. Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1.800.222.5030, Option 4. This warranty gives you specific legal rights, and you may also have other rights that vary from State to State. SR1-MA (Dig.) Rev 08/13/12 Page 2 of 3 Job Number: 16021076 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IFANYOF THE SPACES INTENDED FOR THEAGREED TERMS TOTHE EXTENT OF THEAVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT. KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME, AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY [FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER] AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING "I HEREBY RESCIND" AND ADDING YOUR NAME AND ADDRESS. A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration P.O. Box 871 Taunton, MA 02780-0871 Telephone: (508) 821-9375 Please note that owners who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos -containing material is known or likely to be present in that heating or air conditioning system, or any portion thereof. If it is determined or reasonably suspected that asbestos is present, either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs !, of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work, Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor, hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C.M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above, DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 08/16/2013 08/16/2013 Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products, Inc. ("Sears") on 08/16/2013 by. Date Management Representative SRI -MA (Dig.) Rev 08/13/12 Page 3 of 3 Office Location: BOSTON Proposal Date 08/16/2013 JJob Number 16021076 S� Sears Home Improvement Products, Inc. Customer Name P.O. Box 522290 RUTH MARRION ���� Home Improvement Products 1024 Florida Central Parkway Longwood, FL 32750-7579 Customer's Home Phone 7Customer's Work Phone (978) 618-5125 Phone 800) 469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 80 ADAMS AVE Roofing MA(148607) City State Zip Code All plumbing and electrical services performed by NORTH ANDOVER IMA 01845 licensed subcontractors FEIN 25-1698591 Is installation within city limits? (Yes/No): NO Installation Address County ESSEX Billing Address (if different from above)City State Zip Code Project Consultant Name & License No. (if applicable) ROBERT LOUIS MANSOUR 30408 Description of the Project and Description of the Significant Materials to be Used and Equipment to be installed The work to be done under this contract includes the following (where checked): Specifications (0 = Included ❑ = Not Included) Preparation 1, E Tear off existing roof shingles down to wood deck on entire house. 2, p Inspect wood deck for rotten wood. 3. ❑ Replace any rotten wood found in the deck area at a rate of $ per square foot. PLEASE NOTE: this amount is not included in the TOTAL PRICE shown below. Customer and Sears agree that the TOTAL PRICE will be amended via a Contract Change Authorization form to add the costs of replacing rotten wood in the deck area discovered after existing roofing materials are removed. Customer(s) initials Installation 4. be Furnish and install Exterior Shingle: TYPE: DURATION COLOR: QUARRY GRAY 5, ❑ Furnish and install underlayment over roof decking. 6. ® Furnish and install ice & water eave & valley protector. 7. Z Furnish and install starter shingle on all eaves. 8. 0 Furnish and install/replace any deteriorated "L" flashing. 9. H Furnish and install metal drip edge along rake edges and eaves. 10. ❑ Furnish and install skylight systems. ❑ Reuse existing 11. 0 Furnish and install new vent covers on all vent pipes. 12. Z Furnish and install attic ventilation system (Check all applicable): ❑ Turbines ❑ Power vents 0 Shingle -over ridge vents ❑ Off -ridge vents ❑ Soffit vents 13. ❑ Furnish and install new flat roof Exterior Protection System: COLOR: Gutters 14. ❑ Furnish and install guttering: COLOR: 15. ❑ Dispose of old guttering. Clean-up 16. 0 Clean-up and removal of all job-related debris including excess materials. (Extra materials are shipped with each job to avoid delays). Manufacturer warranty will be sent upon completion of installation. Sears recommends that Customers have their chimney siding or mortar between brick, stone, or blocks inspected periodical) b a rofessional and tuck ointed and/or waterproofed as needed. Sears shall not be responsible for chimney integrity other than Customer(s) initials replacing the flashing in conjunction with the installation of the roofing materials described above. Additional work to be done: NONE Work NOT to be done: Repairs and replacement of any damaged existing structural members. Interior repair to walls or ceilings including sealing, painting, and/or drywall repair. Removal and/or re -installation of items that may otherwise impede Sears' ability to install a new roofing system prior to installation. Examples include, but are not limited to, satellite dishes, solar panels, pool heating panels, gutter protection systems, TV antennas, HVAC systems, and weather equipment. NONE SPECIAL INSTRUCTIONS: NONE All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s) initials "Special Instructions" sections have been reviewed and explained to me. SRl-MA (Dig.) Rev 08/13/12 Page i of 3 Dimension Number of Stories:_ Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions._ ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A -F and G min.$10041000 fine NOTES and DATA — (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The folwuing is list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/CrossectionlElevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apuaal 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.Buikiing Permit Revised 2012 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 maybe-deemed-by_the-Inspector_of_Wires abandoned-and_inYalid.ifhe—. 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. y ❑ Rule 8 — Permit/Date Closed:It�Ot 't * ** Note: Reapply for new permit i ❑ Permit Extension Act — Permit/Date Closed: rofi✓ % I I Date .... ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Pis certifies that ..................................................... I .................................... has permission to perform ... ................................................. wmng in the building of ...... 77)1—d-1-4 . . . . . . ......................................... .................d North Andover, ass. Fee .............. Lic. N41a&? ..............�,W...... E�EcrR iNspR Check # 85x7 7 Commonwealth of Massachusetts Official Use Only J' Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checkedi5_ [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00" (PLEASE PRINTW INK OR TYPE ALL INFORMATION) Date: CD_ — — City or Town of: NORTH ANDOVER To the Inspector f, -Wires: By this application the undersigned gives notice of his or her intention to perform the electrical;�vork described below. Location (Street &Number) A� Q MS s r e P',7'—" Owner or Tenant (� j�?1 /� r^ r- ,t Telephone No. Owner's Address —9'0 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utilify�Authorization No. Existing Service/i!�O Amps y,2Q /,2$/C1Volts Overhead Ok� Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No, of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: ,Cid e �. O v7S,' -Je_ lee q r — L j No. of Recessed Luminaires No. of Luminaire Outlets Gom tetion o. f thelfollouung No. of Ceil: Susp. (Paddle) Fans No. of Hot Tubs table may be waived by the Ins ector o Wires. No. °f Total Transformers KVA Generators .:I— KVA `Q No. of Luminaires No. of Receptacle Outlets Swimming Pool Above ❑ In- ❑ grud. rnd. No. of Oil Burners o, o mergency ig ng . Battery Units FN -9 ALA KS No. of pones No. of Switches No. of Ranges No. of Gas Burners No. of Air Cond. TotaTonal No, o Detection and Initiating Devices No. of Alerting Devices No. of Waste Disposers No. of Dishwashers No. of Dryers No. of waterNo. Heaters KW No. Hydromassage Bathtubs nTuru. Heat PSP _._umber Tons KW Totals: ......_..---._........... _.---..._....... w. Space/Area HeatingKW Heating Appliances KW of Si s Ballasts No. of Motors Total Hp No. o elf -Contained Detection/Alerting Devices Municipal Local ❑ Connection ❑ Other SecuritySystems:* No. of Devices or E uivalent Data Wiring: No. of Devices or E uivalent elecommunications Wiring: No. of Devices or Equivalent �Q �� Attach additional detail if desired, or as required by the Inspector of Wires. y Estimated Value of Electrical Wor . (When required by municipal policy.) Work to Start: ''sd 7 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 suchcovers is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenalties of,perjury, that the information on this p lication is true and complete: FIRM NAME: rQ �-cJ �(2 t.7�� • L 1 ,f % LIC. NO.: Licensee: Signature (If applicablA140, , ter "exem t to the license number line.) LIC. NO.: f !,p i Address: f 1O , c D x 3 9,� � �/� v e ,.i 4 a /8. �y Bus. Tel. No.:97.�' *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt. L c. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE- The Commonwealth of Massachusetts k l Department of Industrial Accidents ..'' Office of Investigations 600 f f cashing ion Street r Boston MA 02111 c j www.nwss gov/dip . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibiv NameBusiness/l?r ) LA <-�e.i le C'7' -' If L Z A,/C , C gani2ation/Individuai : Address: " Q r f City/State/Zip://f 7-1 v,-,1-1 V�i A-01,,PY / Phone #:. Are you an. employer? Check the appropriate box: I. 2I aro a employer with 4, ❑ 1 am a general contractor and I Type of project 1 (requires: employees (full and/or part-time),* 2. ❑ 1 am asole proprietor or partner. have hired the sub -contractors listed on the attached sheet I 6' New construction 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me .in any capacity. [No workers' comp, insurance workers' comp. insurance. S. ❑ We are a corporation and its 9, ❑ Building addition wired-] officershave exercised their 10•-L9 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No -workers' comp, c. 1.52, § 1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.7 Other comp. insurance required.] • -••+ ..r,..•........ t wl"� uuz P 1 mus[ also nit 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. ?Contractors that check this box must attached sn additional sheetshowing the mine of the sub -contractors and their worker' camp, prlicT i;,;a, nation. ant anemployer that is provrding workers' compensation information. insurance for my employees Be10w is the policy and job site Insurance Company Name: C`©M /"e f c C _-r,,.J,S t/ r A ^'c e a�© Policy # or Self -in s.Lie . #: Expiration Date � ---100 �. Job Site Address:l� D r�,qS �'� r e City/State/Zip: �U ,¢.✓�p u�-_ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the at p alti of perjury that the information provided above is true and correct Si airtre: '�� �rt� "hone #: Official use only. Do not write in this area, to be completed by city or town Off, ciai City or Town PermitlLecense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/'Towu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone 4: Date ......r.. .. . Of HpRTM ,ti 3� '` •° °•° TOWN OF NORTH ANDOVER 49 ' PERMIT FOR GAS INSTALLATION SACNUSE, i This certifies that .... `...!................. has permission for gas installation . . G ��- -R- - r ...... in the cabuildings /of, atx'...421 � . , North Andover, Mass. Feel.V. Lic. No.�'=Z.? Q . `,./. �!.4. < ., ...... . /j GAS iNSPECT YR� Check#��� (� 6697 .! I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written-" An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the'foregoing engaged in a}oint 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 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 -contractors) 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 ifyou are required to obtain a workers' compensation policy, please call the Department at the numberlisted 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 infonnation (if necessary) and under "Job Site Address" the applicant should write "ail 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 bum 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. 4 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts kj I Department of Industrial Accidents • Office of Investigations t' 600 ffashington Street '.E< , Boston, MA 02111 V 1 wltvw.mass.goV1&a . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lmgbly Name (Business//O�rganization/Individual): Address: � , 0 City/.state/Zip:A/e it/ --4 n1 A -04Y Phone # / ,,I r ,14.4- 2 Are _von an. employer? Check the appropriate box: 11 I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).' 2. [] I am asoie have Hired the sub -contractors listed � proprietor or partner. on the attached sheet. ship and have no employees These sub -contractors have working for me .in any capacity, workers' comp. insurance. [No workm' comp, insurance S. ❑ We are a corporation and its required.] 3.❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No -workers' comp. c. 1.52, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. [J Demolition 9. ❑ Building addition 102 Electrical repairs or additions 11.17 Plumbing repairs or additions 12.❑ Roof repairs I3.❑ Other t Home e , •- •w• �— . cox n I MUST also nu out the section below showing theirworkm' compensation policy information. owners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub- contractors and their workers' temp. polis; law ,ration. I am an employer that is providing:workers' compensation'nsuramefor my employees: Below is the policy and job srte information. Insurance Company Name: ' C©/" /^ e r c- C—_ T,Js v r A I -"-Q- - CQ Policy # or Self -ins. Lie. #; Expiration Date/91!i --I 00 Job Site Address.e- e City/S&-e/Zip: /Z4O WAIV Jo AA 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 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. MASSACHUSETTS UNIFORM A,PPUCATON FOR PERM TO DO GAS FMING (Type or print) ,�' f � —) NORTH ANDOVER, MASSACHUSETTS Date _tr; h C� Op Building Logations b pf,Fr % Permit # R( yI / � /J� ,Owner's Name Amount $ New Renovation D Replacement ❑ Plans Submitted SU B-BASEM ENT BAS'EM ENT ]ST. FLOOR 2ND. FLOOR 3RD. FLOOR 7TH. FLOOR iTH. FLOOR iTH. FLOOR �TH..FLOOR. ITH. FLOOR (Print or Address mess It,h, �J,hs # C1�� f FvI W U o a w a � W C G� W OF. W� W U W � C> Z d W a F Z F W It,h, �J,hs # C1�� f FvI Check one: Certificate Installing Company Corp. . Partner. s® e�-5 y Wj Firm/Co. _ Name of Licensed Plumber or Gas Fitter IN _U COVERAGE I have a current liability lnsurancrpoli�r it's substantial equivalent Check one: If you have checked es please in 'date the a cove Yes No0 Liability insurance policy type rage by checking the appropriate box. P cY Other type of indemnity D Bond Owner's Insurance Waiver. I am aware that the licensee does n_at have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: 1 hereby certify that all of the details and information 1 have su i Owner, 13 Agent 1 best of my knowledge and that all plumbing work and ihave at (or entered) in above application are true and accurate to the compliance with all pertinent provisions of the Massach Performed u r e Is ued for is application will be in State Gas Code Ch of a eneral Laws. By: Signature of Licensed Plumber Or Gas_Fi r Title .Plumber City/Town•. Gas Fitter icense um er DMaster 4PPROVED (OFFICE USE ONLY) Journeyman o a w a G� r O Z W C C> O a cam. Check one: Certificate Installing Company Corp. . Partner. s® e�-5 y Wj Firm/Co. _ Name of Licensed Plumber or Gas Fitter IN _U COVERAGE I have a current liability lnsurancrpoli�r it's substantial equivalent Check one: If you have checked es please in 'date the a cove Yes No0 Liability insurance policy type rage by checking the appropriate box. P cY Other type of indemnity D Bond Owner's Insurance Waiver. I am aware that the licensee does n_at have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: 1 hereby certify that all of the details and information 1 have su i Owner, 13 Agent 1 best of my knowledge and that all plumbing work and ihave at (or entered) in above application are true and accurate to the compliance with all pertinent provisions of the Massach Performed u r e Is ued for is application will be in State Gas Code Ch of a eneral Laws. By: Signature of Licensed Plumber Or Gas_Fi r Title .Plumber City/Town•. Gas Fitter icense um er DMaster 4PPROVED (OFFICE USE ONLY) Journeyman Location a ►�� ►a ut S IiVt ' No. 7!5 Date V?O 3 NOn TOWN OF NORTH ANDOVER 0�,.o ,h0 p Certificate of Occupancy $ -5-0 =' Building/Frame Permit Fee $, Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water, Connection Fee $ �uV T6TAL $ Building Inspector 6383 Div. Public Works IEEIJt[T NO. 7�� APPLICATION FOR PERMIT TO BUILD —NORTH ANDOVER. MASSA"La/) X11 V V-5� /PAGE 1 PAGE — I MAP +40. LOT NO. 3 I 2 RECORD OF OWNERSHIP IDATE BOOK ZONE SUB DIV. LOT NO. LOCATION U� A�S �vtf PURPOSE OF BUILDING OWNER'S NAME C�1,q 1'7 Q'Ll \ - NO. OF STORIES ( I SIZE OWNER'S ADDRESS (J !J�"I 8c� ^ c)r pl,5 v� ' BASEMENT OR SLAB 'ISTL ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 2ND SPAN ;-t /I' 3RD 32!,)<31'/ !�3��� BUILDER'S NAME Lti�-J DISTANCE TO NEAREST BUILDING 30I_7- DIMENSIONS OF SILLS AV'1 Qvs 11 2tz DISTANCE FROM STREET 3 J �� POSTS G,A V� '31 !� T DISTANCE FROM LOT LINES - SIDES I / / Lp REAR 10 TO GIRDERS FRONTAGE AREA OF LOT �LL o4 IS BUILDING NEW TT 1lND /'�/,� l(/V HEIGHT OF FOUNDATION THICKNEB L SIZE OF FOOTING X F 10LY#J00.3 " IS BUILDING ADDITION IV0 MATERIAL OF CHIMNEY IV04 G ARACT t11 wo "1 '-i IS BUILDING ALTERATION �w IS BUILDING ON SOLID OR FILLED LAND 96oP WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yQS J IS BUILDING CONNECTED TO TOWN WATER I "C S BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 11 IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 . JIT a� ..... LI DUE F 'PERMIT $ 1 sem- i ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLA S MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED ll I I I SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE �OS PERMIT GRANTED A t9 g.3 0 OWNER TEL. N CONTR. TEL. # CONTR. LIC, rY Sc iI,; G 1 9 'g 3 PROPERTY INFORMATION LAND COST 4'7 000 EBT. BLDG. COB fid! floc) EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN awlLgI�V INWrCGTVR BUILDING RECORD 1 OCC FANCY 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA - RAGES. ETC, SUPERIMPOSED. THIS REPLACES PLOT PLAN. -• SINGLE FAMILY I STORIES 1 MULTI. FAMILY OFFICES APARTMENTS I UNFIN±nL CONSTRUCTION 2 FOUNDATION B INTERIOR FINISH 3 I I3 PINE _ HARDW D _12 _ —� CONCRETE CONCRETE BL K. BRICK OR STONE 6 FRAMING II 11 HEATING WOOD JOIST I II PIPELESS FURNACE I 7 NO. OF ROOMS OI L B'M'T 2nd ELECTRIC 1sr 13rd I NO HEATING s� UNFIN±nL 3 BASEMENT AREA FULL FIN. 8'M-TAREA _ '/ 1/1 '/, 11 FIN. ATTIC AREA N_O B M IRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING _ HARDW D _ _ _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME _- yS�rsrR BRICK ON MASONRY ATTIC STRS. b FLOOR BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING _ , a� •>r! �.► s� STONE ON FRAME •� SUPERIOR I� POOR _ ADEQUATE NONE $ ROOF 10 PLUMBING r GABLE I I HIP BATH (3 FIX.) GAMBQEL MANSARD TOILET RM. 12 FIX.) fLATSHFD WATER CLOSET - ASPHALT SHINGLES LAVATORY 6 FRAMING II 11 HEATING WOOD JOIST I II PIPELESS FURNACE I 7 NO. OF ROOMS OI L B'M'T 2nd ELECTRIC 1sr 13rd I NO HEATING s� 6 P *_�) -7 S--� FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** ✓APPLICANT: NA (60 �t � Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) �reet �0 1 NMS I u'17- N0 4NDv�W, St. Number ************************Official Use Only************************ RECOM4ENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected - driveway permit i /Fire Department � � i F F' e-11 r Received by Building Inspector Date 0 91993 � Fj,fit� _711. h 4 Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE JOB LOCATION 80 ` -S Number Street Address Section of town "HOMEOWNER" W ( (3 D; M'tGe►�� rp$�o��i�0% �(- S89— WG Name Home Phone Work Phone PRESENT MAILING ADDRESS ��My jV O , jYUk) 0'/f 1< , 018 City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six 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 109.1.1) DEFINITION OF HOMEOWNER: 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 to six family dwell- ing, attached or detached structures accessory to such use aid/or farm structures. A person who•constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit .to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE �g APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. 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