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Miscellaneous - 835 CHESTNUT STREET 4/30/2018
0 CL Location ( �) No. 2c)(,(o Date -:4 0 Check# TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $- Building Inspector NORTFI BUILDING PERMIT o��tye° TOWN OF NORTH ANDOVER o ; - - • . APPLICATION FOR PLAN EXAMINATION * _ Permit No#.1L, �A I� Date Received p°RICH gSSACHU`��� Date Issued:—6 l IMPORTANT: Applicant must complete all items on this page LOCATION IF— Pn PROPERTY OWNER tint 100 Year Structure yes no PARCEL: ZONING DISTRICT: Historic District s no MAP API— Machine Shop Village, yes_ _ n TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ AI ation epair, replacement ❑ Demolition ❑ Septic p Well ❑ Water/Sewer OWNER: Name: Address:__ PROPOSED USE Residential Non- Residential ,e One family ❑ Two or -more -family ❑ Industrial No. of units: ❑ Commercial ❑ Assessory Bldg ❑ Others: ❑ Other ❑ Floodplain ❑ Wetlands ❑ Watershed E TfTIORK TQ BE ]PERFORMED: , Print Clearly Phc Contractor Name: , ©(b Phone Email: _ Address. Supervisor's Construction License: Exp. Date: Home Improvement License: -(ala Exp Date: ct. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $> FEE: $_��_� Check No.: 1 /i � Recei 30��(e7, NOTE: Persons cont%cting with ✓ egistered contractors do n9f ha e c �s t, e guaf anty fund IE 11 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit H.I.C.hoto Copy OfAnd/Or C.S.L. Licenses ❑ ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ ducts Engineering Affidavits for Engineered ppe artment prior to issuance of Bldg Permit NOTE: All dumpster permits require sign off from Fire p Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit CaAnd C.S.L. Licenses ❑ Photo Copy of H.I ❑ Copy Of Contract n/Elevation Plan Of Proposed Work With Sprinkler Plan An ❑ Floor/Cross Sectio Applicable) Hydraulic Calculations (If App Applicable) ❑ Mass check Energy Compliance Report (If App ❑ Engineering Affidavits for Engineered products De artment prior to issuance of Bldg Permit NOTE: All dumpster permits require sign off from p 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 Building Plans (One To Be Returned) to Include Sprinkler Plan An ❑ Two Sets of B g Hydraulic Calculations (If Applicable) ❑ Copy of Contract Compliance Report o Mass check Energygvit for Engineered products Engineering Affida NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit special permit was required the Town clerks office must stamp the decision from the Board of Appeals In all cases if a variance ors p and roof of recording that the appeal period is over. The applicant must then get this recorded at the Reg istry of Deeds. One copy must be submitted with the building application Doc: Building Permit Revised 2014 — 1 -W O 4no 0 E%-* x x LL O O m C sate+ o LL E ?O VI u Q N O F- V H Z Z m C +' f0a 7 LL t to ? c U _ LL O UU W CL H Z z m .=.1 d c 3 ns LL 0 W0 CL H Z U U(' W W c j d' �_ N LL U Wa z Q r .7 LL Z W oc Q W W U. v m Z N 41 N }; p Y O VI O 0 V .W 0. In Q. d : N O +•. : Z . r O Z O Cl) I-- I-= Q O H h c • P : J 0 O :N C', _ F- � N W w C 0 =oma > —y CL = X z O «._.t.c O W �. :_. � E o o � H V s CLC—C • y p t . 0 d G - N C W �•> p _C W J a az d 4) t w m c L _ w 'U O �+O F-- 2 d rL N CO)cc .-. W_ O -c— O O � u1i LL •� N M N C O •C t O W V a O -0 O .r U) > :F. _ N = O O F=- s . aov > E O c.i z O O � a C4 0N •E m m 2 CL 4 O �0 0 a CL � Q OM a .CL O 4) z O CL V U) MA Reg 0146588 -697i!>63 Federal ID #202625128 CT Reg #D605218 Contract* RI Reg #28483 Home Improvement Solutions � Corporate Hea 26 Cedar St, Woburn, MA (I) 800342-2211(F) 7811933.9620 (N) wwwmawpm.com ' THIS CONTRACT MADE TtiE 7_ -. day ot_7 l4 t 2Q_L(�—betwo-L'ateJ.9,—b 66-4 97k,47,'r-s77k q7F;A7.7-X332 Of 5'- d bea-rn U -r S7 are "Ovmee and NEWPRO Operolfng, LIC,'NEWPRO-. (E -Nell} Jor prapdatoy ase only NEWPRO hereby gess that It YAli, for the considerationherebrefter mendorted, furMsh all 1abo1 end material necessery to install Ota goods pwohesed by Owner in socardanee with the terms download on the front and the reverse of ads agreement and on the accomporying spatdOcaton sheet(a) (oo iectively, We Agreamorin at the premises looked at: Tha)ob address to a condomkdunn (Job Address) mr-a souDViNYI.SIDiNoawonryhotwellereasdedpatedfordtr% exdepttho are d 8ize�corN 9 i Pshern'�.� `!Package Custom Comerpoelat teodSIDSNGwnheeppkadtothe (dtiWNngareas only: 11 Past a Ovwd : /^ 5re ❑ DetenR � n f] LItJcSi..r� two tusutnnoN dorero,�rl�lrratl areas aesigrnsdd ror sldMg win 0 Fitted DoOM Inch o alb Inch o%Other p_ vii StdingtdbaepplledoVinEXISTINGFOUNDATION, ' t7",O Use uprated FW" TRIM wAma wrrbao[or deams necesaary, in same color es ald'mg. (Not evaBable vier NOUN) q.M----WNDOW OPENINW U Cuabm wrap wtbr approved vMyl clad oWnum 0 t/' - Caw zjA,-1'L O Cbvnol erdsdng vdndexo*(eg. Andeaah type orproms vowad) A coos _ Other Detans fYo _CAt�RK all "with mbbenxed odor mordlmaed caulking O 03-0 RS custom vaso witlr approved VKA LOAD AUNNUUM. # Doon Coin Surround a RAGE DOOR FRAMES custom wrap xith approved VINYL CLAD ALUMINUM 0 Sbgle O bovW%fithMuil 13 DouttrNoae,a W13 -1 --ASM, uafamwrepwMepprovedVINYLCLADAWMINUM Color z f7 t h Qf,t � SDFFIT (ea"aftyarhangs) comer Wier approved SOLID VINYL SOFFIT SYSTEM. Excepted asked to (125.113 Vented Cdor rj_J 14 1 IOLK via ROTTEN WOOD Win only be repaired or replaced where spedbed on fine earn 826. Ary addWon*l areas needing repair Will be eatkratad upon their crocovery and priced accordingly. (Doan not inciWa wood duds, or exterlor aheatarg.) R(eMO CNG MATERIAL exbddr of house to Wow! Sid'ep � Q Alumlrwm p Wood ShWoo D Other Q '40-N CEILINGS cover wttrapprovedSOUDVMYLCEIUNGMATERIAL In the falgng areae: -18 G D"18 -M (COLUMNS wrap with approved VINYL CLAD ALUMINUM. (me circular or round columns) calor 10 O WO GUT 'ERSIDOWNSPOUTS remove erdsting WW (cptsm with new custom ti!p loss guaers and downspouts O WMfs G Brown Otter 17 O fY//CHUTTERS provide & h" ! pair approved fwlystylane shuters. • Styaes ' Color is D O MASTER MOUNTS Q�� Ida & hsteu exterior RO RAW SOW 19A.) LIghIS # � v 168.) Wated Esed Outet# 18C.) Dryer Vent # .2- _ Cor 45 % a.T' 18 O 17 GABLE VENTSproAde and hiatal - • venh. / Color r'J /r4i<3 No WcularortemilleveMO. 20 'e /a/CLEAN UP properly.at coetp"m cf wdr. 21 IRS o INSURANCE AO YVWMWft CohtpelWatIM and UAWidy to ba meimekied. 22 U015 WARRANTY MOR to customer after completion & full pgrnerd Is received. 23. {�PAYMENTSonNON-FINANCED orders- Installer Isaull0ft0dbmReN � �mrasslvepaym nis 24 W' 13Customer asked W remove txeskebles from wails 25 9,Al"ADOITIDNAL WORK (rmt spedifled ebove) 9..E 9= t'� V- A , bofarrvY 11i ir3bFtGn:7 k7� 26 11 Q WorkExcluatons Sj^cLPIJ IST te'e 27 L) U Repairor Replace me fo0owhlg woodsor Replace woods 0k5e! ( 96.W} Es! Start Acta: �I i fi EIL comp. Daren -!I Customer understands Ode is an "aadmatad data"- ,:5,✓f +L . Owner has read and agrees to the terms and conditions on the front and rim reverse of this Agreement. Owner speatttgllly agrees to the (1) Tota) Cash Price; (2) work being performed; and (3) work not being performed, Owner understands that this Agreement and any attachments contain all of the promtses made by NEWPRO. Owner has been oreliy advised of his right to cancel this prior to mtdrdght of the third business day afar the date of this transaction and Owner was provided with two (2) copies of a cancellation form explaining this tight, DO NOT SIGN -THIS CONTRACT -IF THERE ARE ANY BLANK SPACER. (Rhode Island $ales Only): Notice to buyer: (1) Do not sign this Agrsemed If any of the spaces Intended for the agreed forms to the extent of then available Information are left blank. (2) You are entitled to a copy of thta.at the time you sign It, (3) You may at any time pay off the full unpaid balance due under this Agreement, and In so doing you may be entitled to receive a partial rebate of the finance and insurance charges. (4) The sallorbas no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement. (5) You may cancel this Agreement If ithas not been signed at the main office or branch office of the selier, provided you notify the sailer at his or her main office or branch d Ag office shown In Unraament try iregistered or eerttf(ed mai); which'shall be posted not later than midnight of the third calendar day after the day on which the buyer -signs the Agreement, excluding Sunday and any holiday on which regular mai! da0veries aro not made. See thb acboinpohylei(j rtottce of cancellation form for an explanation of buyees rights. (Rhode lalsnd-Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing Board consumer education materials. Owneeg inaials 60L0: F.Mme d MIR - M. 1 '11C. ' aRw�`r�'- ( 96.W} Es! Start Acta: �I i fi EIL comp. Daren -!I Customer understands Ode is an "aadmatad data"- ,:5,✓f +L . Owner has read and agrees to the terms and conditions on the front and rim reverse of this Agreement. Owner speatttgllly agrees to the (1) Tota) Cash Price; (2) work being performed; and (3) work not being performed, Owner understands that this Agreement and any attachments contain all of the promtses made by NEWPRO. Owner has been oreliy advised of his right to cancel this prior to mtdrdght of the third business day afar the date of this transaction and Owner was provided with two (2) copies of a cancellation form explaining this tight, DO NOT SIGN -THIS CONTRACT -IF THERE ARE ANY BLANK SPACER. (Rhode Island $ales Only): Notice to buyer: (1) Do not sign this Agrsemed If any of the spaces Intended for the agreed forms to the extent of then available Information are left blank. (2) You are entitled to a copy of thta.at the time you sign It, (3) You may at any time pay off the full unpaid balance due under this Agreement, and In so doing you may be entitled to receive a partial rebate of the finance and insurance charges. (4) The sallorbas no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement. (5) You may cancel this Agreement If ithas not been signed at the main office or branch office of the selier, provided you notify the sailer at his or her main office or branch d Ag office shown In Unraament try iregistered or eerttf(ed mai); which'shall be posted not later than midnight of the third calendar day after the day on which the buyer -signs the Agreement, excluding Sunday and any holiday on which regular mai! da0veries aro not made. See thb acboinpohylei(j rtottce of cancellation form for an explanation of buyees rights. (Rhode lalsnd-Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing Board consumer education materials. Owneeg inaials 60L0: F.Mme The Commonwe M ofM=wAuseM Dep& tont of *&MlAccidettts I CongressSOM4 Suite 100 Boston M4 02114-200 www.mamgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EleMciansMiu*ers. TO BE FILED WITH THE PIPJd 1IJTG AITI'HOPM. Plan WN IA Name(Business/otion%lndvdnel);xn Areyou7�, ploW a apprsptf ate bolt: 1. I aya to 14 full sad time 2.01 am a sole puupQtebrarpertperahip Lavc ao emplgypes w01i*g forme in any �ty:'(No wcsiair' iia 7 ' 3.Q I am s homeowner doing all work myself. [No wmkas' emp. M arance r qubed.) t 4.Q I am a homeowner and wM be him % eanftctms to eoubw all wodt am my property. l wffl eawe that all comracte� ei8rer have wroskers' compensoion insurance tware sole poprietps:w�thaoampioyae�. S.Q lam a general coim i amid I bn a hfiM the listed on Resta d gieei: 1Lyeesv�cpmtrtacoods Gave e�ployeea and have worked• pomp, ;,,�+��_ . 6.Q We, are a corporahOw. !b 0. Gc S$have eaeicrsed theiringha of aunmphao perMGL c. 152. X1(4). and **,be* tb edVJq e3 {Nc w'ariOeis' Cdep `losuiance regitiad j' 'Arty app>ooc t#1 iii t Homeowners who s, da ift* tContracm that cbeck.tbrs but Am Iain an,awrployer. that 4rproviding war Jyera' co trlipn iwwwwfor to orniado� Insurance Company N8me:Ar 911A. of ro ect T i.:,:c ) 7 O New canamtetam 9.03 Dbm6Vd6n` 10 Q Biding sdio9u . 11.0 Electrical repairs or additions f 2 Plumbntg t+epams ac addmtiiys must anew afbdevit i sucL: bfik ass'andOde :wbelhOwnw1hose have Cwt ..... .., .... ' ' _ Policy # or Self -ins. Lic. t Fapiration Date: Job Site Address: JSta Cit'► te/Zip: Attach a cuff of the wor kei^a' compensation policy declaration page (showing the policy n.er and espiretion ate). Faawe to setatrecoverage as inquired ander MGL c. l S2, �25A is a taimtnal violation puntahabk bya fine up to t1,500.00 . andlor one-year Wit, as well as tii rp malt cs in the foam da STOP WORK ORfiER and 8 fine of ap.to 3250.00 a day against the vidlaiot. A copy of this statei eat imy be forwarded to tree bffice dInvesfJgaticns.ofthe DIA fat msiutmt e I do hereby O,(%teW ase only. Do not write in this area, to be coeipleled by, or town o0 iat trae and comma City or Town: PermitaJeense # Issuing Authority (eirek one): 1. Board of Healtb I Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Phunbing Inspector 6. Other Contact Person: Phone #: AC<Rim CERTIFICATE OF LIABILITY INSURANCE DATE �29�20' s' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION.IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER coNrACT Melissa Pflu NAME: g Mackintire Insurance Agency IncPiH0 11 West Main Street N E (508)366-6161 AIC No: (508)366-5202 E-MAIL melissap@mackintire.com ADDRESS: P INSURER(S)AFFORDING COVERAGE NAIC # Westborough MA 01581-1931 INSURER Netherlands 24171 INSURED INsuRERB:Libert Mutual Peerless 24198 INSURERC Acadia Insurance Co. Newpro Operating LLC 26 Cedar St. INSURERD: INSURER E : Woburn MA 01801 1 INSURERF: COVERAGES CERTIFICATE NUMBER:Master 15-16 REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. IL R TYPE OF INSURANCE POLICY NUMBER MMIDDIYYY MMIM EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADEmx OCCUR PREMISES Ea occurrence $ 100, 000 MED EXP (Any one person) $ 5"000 CBP8589577 12/31/2015 12/31/2016 PERSONAL.& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO D JECT LOC 2,000 000 PRODUCTS - COMPIOP AGG $ i $ OTHER: AUTOMOBILE LIABILITY Ea accident IN M T $ 1; 000,000 BODILY INJURY (Per person) $ A ANY AUTO ALL OVaNED X SCHEDULED AUTOS AUTOS BA 8584174 12/31/2015 12/31/2016 BODILY INJURY Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident Uninsured motorist BI split limit $ 250,000 X UMBRELLA As X OCCUR EACH OCCURRENCE $ 5 000 000 AGGREGATE $ 5,000,000 B EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10,000 $ CO 8582578 12/31/2015 12/31/2016 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N ANY PROPRIETORIPARTNERIEXECUTIVEE.L. OFFICERIMEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NLA WC -20-20-003506-02 5/1/2016 5/1/2017 X PER OTH- STATUTE ER EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Excluded Officer: Nicholas Cogliani CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To Whom it May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE T Moynagh/DORRIE ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I ^ a . FolJ1!11'In'n :;i1i.1 _ _•;"�,,._. CS -029090 PAUL FOXON 730 WALNUT S t DREADING M.41 01367 1. F ...:, ,._ .. _. 111iM017 _4 I a All gulatil)PI ines -,nsumnsumash of ace of 16 I.K ch j .MAN THOMAS MAS FOXO""' 26 GPDAR S� �-i 81,013URN, 1 $C?.1 a �C�lT,�3ritY a .— • _ iiice ai4consumer Lsn' L Basiaeas iie;nta>�on � �fq]E !1�1!?ff� lfitt I i COM GTOR ` � �� �eglatratin � �; ,r �upal3mant rs;u ( jEkjVPRC Regle1ra11an- 1,9589 Type: SupplemerltG�ld S„plmtlon: 5151241? address and return tarn. {ark resson far char •. Li --- r�ss 0 Reue'?!ai o sQrs$on vaIId ios tad�iscdnla�.u'se ouiy %IE9Ii68 ar Cege r d rade ca: be orethe �iration date.H ne �gta�ion £3ffifics of consum T AfmS - 15 Tsr?c plezn -suite sZ7Q -3,waa, '.lily o I;i©'•lA -' �K r_—^— „ al ri?iltll0il 26ip,tri- BURN, C�ia Location No. Date ��I 4P Check# � 2)7-7-2— TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $ Building inspector t �J- V�� BUILDING PERMIT 3?�e4t�eo a•{,\ T TOWN OF NORTH ANDOVER ° o APPLICATION FOR PLAN EXAMINATION f,, h Permit NO: o � J" / Date Received Date Issued: TANT: ADDlicant must complete all items on this LOCATION Eli3jSrr- Print PROPERTY OWN Print I I MAP NO: PARCEL: ZONING DISTRICT: Historic [ Machine TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1<0ne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other C Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: 'A� � Gam---� �" Phone: V- ?S`t • 053o Address: ?,3 S - CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: U � t;z�t 6 �zk ( Lb ARCHITECT/ENGINEER P.,vti►Q Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. MOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ l2. SU D FEE: $ lSp Check No.: 1 'y Receipt No.: ?:g�1-� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of AgenUOwner Signature - f contractor �„� �' u .. r n Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ■ ■ COMMENTS DATE REJECTED HEALTH COMMENTS DATE APPROVED 11 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no COMMENTS Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost C 129,5001._00 m $ - $ 150.00 Plumbing Fee $ 18.75 Gas Fee 100 comm. $ 100.00, Electrical Fee $ 18.75 Total fees collected $ 287.50 835 Chestnut Street 1004-2016 on 3/26/2016 Second Floor Bath Remodel A .0 0 0 CD e� CD v z CD a m s low m � Cn Z O cn ►!a o00 2 o (D,0.0n CL 0 3 m o s � .a vi o O .*CL 0 m (D (D = C l'1 to a, .-. O r. c0'1 (D D � (D ( (D 'Q ; C < �I <_ o�� z CD O 0. a :� C CD N a 0 >o — 3. T CL < _ N . N < (D (n CL W@ T N Nr 'a (D O O O . 3 rr O °a �. CD O CD j' O CoCD C� S O O O Do (CD -Oa @ 0 SU o C O (n ': Ln co T xT (n � T Z7 T 3 rr O 7 O 3 rD O j' O S O O O O - S n rD Z r (D S S 7 m S a m n N \ rD O < '• -< � O = S m C W C 3 ' W 70 %i ° °Ln W C1 Z ° v N D G) 0 e) N N N 2 m m O n n ���� 98 Forest Street Kevii,M h-- North Andover, MA 01845 • PH: 978.688-5335 Building Contractor • FAX: 978-688-7207 Proposal To: Rick & Diana Gaudet 835 Chestnut Street North Andover, Ma. 01845 From: Kevin Murphy CC: Date: 3/20/2016 Job: Bathroom Date of plans: Architect: Location: Same Section 1- Work Schedule All Home improvement Contractors and Subcontractors engaged in home improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and Status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02106. (617)-727 8598 Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 4/1/16. Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 6/30/16. The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section 11- Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section 111— Scope of Work Page 1 of 4 Kevin Murphy Building Contractor 98 Forest Street North Andover, MA 01845 PH: 978588,5335 FAX 978586-7207 General Proposal is to add second floor bath Page 2 of 4 Building Any framing materials will be provided Plumbing Plumbing required to provide new three fixture bath will be provided. Owner to provide plumbing fixturres. Electrical Electrical work required to wire bath to code will be provided Heating/Air Conditioning Existing heat will be relocated / added as required. No allowance has been made for any air conditioning. Insulation Bath areas will have fiberglass insulation installed to meet code. Plaster Bathroom will be plastered Interior Trim/Doors Pre -primed interior trim will be supplied and installed to match existing. Bath vanity / countertop to be supplied by owner. Flooring Tile floor will be provided in bathroom. An allowance of $6 per square foot has been included for tile materials. Painting No allowance has been made for any painting. Waste Removal Construction debris will be disposed of by contractor. Kevin Murphy Building Contractor 98 Forest Street North Andover, MA 01845 PH: 978688 5335 FAX 978.6W7207 Section IV - Price Schedule Total Page 4 of 4 We hereby propose to furnish material and labor - complete in Accordance with above specifications for the sum of .....................................$ 121500 Payment to be made as follows: Percentagentem Description Amount 1 Permit obtained $1000 2 Rough plumbing complete $3000 3 Plastering complete $4000 4 Trim / the complete $3000 5 Job 100% complete $1500 5 $12,500.00 "Notice: No agreement for Home improvement contracting work shall require a dawn payment (advance deposit) of more that one-third of the total contract price of the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever is greater Contractor: Kevin Murphy 98 Forest Street No. Andover, MA 01845 Registration No: 101874 Section V - Acceptance Acceptance of Proposal — I have read this document and accept the prices, specifications, and conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature `zLif Date 31z31L� Signature Date The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERI n -MG AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: t it„ t,,.. Phone #: Are you an employer? Check the appropriate box: 1.fq I am a employer with_employees (full and/or part-time).* 2. ❑ lam a sole proprietor or partnership and have no employees working for mein any capacity. [No workers' comp. insurance required.] 3.n I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. Remodeling 9. Demolition 10 Building addition ILL Electrical repairs or additions 12.0 Plumbing repairs or additions 13.E] Roof repairs 14. ❑ Other 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. Iain an employer that is providing ivoi lrers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G ,,� 'L,..S , 0, , 1 Policy ff or Self -ins. Lic. ff: kZ- w <. 63 3 `13 '1 Expiration Date: Job Site Address: S31 C" 4 -,,...,*T- f t- City/State/Zip: t-4. P•. k c— o t.",5' Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under thepains andpenalties ofpai jury that the information provided above is true 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 Cleric 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 7/15/2015 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELYOR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVEDR PRODUCER, AND THE CERTIFICATEHOLDER. IMPORTANT: N the certificateholder is an ADDITIONALINSURED,the policy(ies)nust be endorsed. H SUBROGATIONIS WAIVED,subject to the tennsandconditionsof the policypertain policiesnayrequireen endorsement statementon thiscertificatedoes not corderrights to the certifirateholder in lieu of such endorsement(s). PRODUCER M P ROBERTS INS AGCY INC 1060 Osgood Street g North Andover, MA 01845 CONTACT NAME Sandi Munroe PHONE FAX (AVC, No, (978)683-8073 vc,Ne: (978)683-3147 ADDRESS: sandi@mprobertsinsurance.com X COMMERCUILGENERAL LIABILITY INSURER(S) AFFORDING COVERAGE NAICd INSURERA: MERCHANTS INSURANCE INSURED KEVIN MURPHY BUILDING & REMODELING INSURER B: GUARD INSURANCE 169 BOXFORD STREET INSURERC: NORTH ANDOVER, MA 01845 INSURERD: INSURER E INSURERF: PREMISES Ea aaurtenm $ 500,000 COVERAGES CFRTIFICATF NIIMRFR Qc�mm�nk rJ11aAQCQ• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN LS SUBJECT TO ALL THE TERMS, EXCLUSIONSANDCONDITIONS OF SUCH POLICIES LIMITS SHOWNMAY HAVEBEEN REDUCED BYPAID CLAIMS. iAsn TYPE OFINSURANCE wm POLICY NUMBER POLICY EFF POUCY EXP LIMITS X COMMERCUILGENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 PREMISES Ea aaurtenm $ 500,000 CWMSNWDE A 1 OCCUR 1� MED EXP(Any-epe—n) $ 15 000 A BOPI068945 1/22/14 1/22/15 PERSONAL& ADV INJURY $ INCLUDED GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY M J—E6 LOG PRODUCTS-COMP/OPAGG $ 2 000 000 $ OTHER: AUTOMOBILE LIABILITY ECOMBIINNaEDnSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ A ANYAUTO ALL OWNED X SCHEDULED AUTOS AUTOS MCA7013608 1/23/15 1/23/16 BODILY INJURY (Per acddent) $ NON -OWNED HIRED AUTOS AUTOS(Per PROPERTY DAMAGE awident $ $ UMBRELLA UAB DOW EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIM CUP9145304 1/22/14 1/22/15 AGGREGATE $ 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION X I PER OTH- Be� AND EMPLOYERS'LIABILITV YIN Ae M N/A STATUTE ER E.L EACH ACCIDENT $ 500,000 E.L DISEASE -EA EMPLOYEE $ 500,000 (Ma mlaeoryn NH)w KEWC633734 7/01/15 7/01/16 If yes' desaihe under DESCRIPTION OFOPERATIONS below 500 000 E.L. DISEASE-POUCY LIMIT $ / DESCRIPTION OFOPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Sdred de, may be aradmd B mom space is kegkdmd) CERTIFICATE HOLDER r:ANrFI I ATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFII BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25 (2014/01) The ACORD name and logo are registered marks of ACORD � §k,§ Z 2bLU E>k,,.'. 0. .2 G 2LU E 0 0 x § ®% Q `x j �\$. ƒ § z > \ i < $ 2 § 2 --�— Date ... // !lq .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............ has permission to performA ... . .............................................. plumbing in the b *ld* f ..... ;1h; , il atx�? . ........ .... ........ F e e L i c. N o Check # jo) (, I 'orth ndover, Mass. 'I P*'**". ................... i�� �U�Bl G E t t'f MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY v MA DATE a� -( PERMIT # JOBSITE ADDRESS ,� be 1 h l OWNER'S NAME POWNER ADDRESS S ' z:�, ZaL4 j TEL �� IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: II/RENOVATION: ® REPLACEMENT: PLANS SUBMITTED: YES NO I FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB =2 CROSS CONNECTION DEVICE _ H DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN F-uuu uISF'U5t_K FLOOR /AREA DRAIN INTERCEPTOR (INTEL KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING ETHER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES UINO E-11 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY U" OTHER TYPE OF INDEMNITY 0 BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER M-1 AGENT 101 SIGNATURE OF OWNER OR AGENT 1 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 bei plia a wi II rti t pro 'ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ,��� iILICENSE # SIGNATME MP El JP CORPORATION D# PARTNERSHIP Q#LLC COMPANY NAME ,L �_._ �G�/�y1 7'flADDRESSI / 1!k ✓ /� j CITY " 1 G _.__._..._ISTATEJ I ZIP TEL ��p11 - FAX CEL T_ _3�. MAIL --- ---------- The Commonwealth of Massachusetts Department of IndustriqlAccldints Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): ��/ e(, `in'1 --L", Address: 1 TA Yvt.9✓,4 C A City/State/Zip: f . / en, S G k.---- P /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. FI New construction e oyees (full and/ox part-time).* have hired the sub -contractors 2. a sole proprietor or partner- listed on the attached sheet. # �• F1 Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp, c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then.hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. /„)-- Insurance Company Policy # or Self -ins. Lie. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 cern under, the that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # ipr /NC) f 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 #: Il 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 insu-fance 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 Massachv.,sPtts Department oflaadustrnial .Accidents Office ofInvestigationa 600 Washington Street Boston, MA 02111. Tel, # 617-7274900 ext 406 or 1-877,MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass,govNia K Date .... ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING (, L6�7n.l ........................................... This certifies thatl"3 ............... ... i(�� ......... ............ has permission to perform .................. ................. A.cv� ... .................................................. wiring in the building of ........ ............ . -e i e— ............................................................................. at ............... �3.!5 ........ Q—)" . ................ . North Andover, Mass. ................................................ Fee... 55 ............. Lic. No. .................................................................................... ELECTRICAL INSPECTOR Check # 2 Commonwealth of Massachusetts a Department of Fire Services aM BOARD OF FIRE PREVENTION REGULATIONS Official Use 0n1 Permit No. I Occupancy and Fee Checked Lev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 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: �/— .5 — /1i 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) C -7t he- & Nt/ t L Owner or Tenant Telephone No. Owner's Address _ �'-----� Is this permit in conjunction with a buildin permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building j341% ",07 4,.,.ro b Z Utility Authorization No. - Existing Service AmpseeZfVoltsOverhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location andNatureof Proposed Electrical Work: ,g+%�,, .1)C -/f Comnletion ofthe fof9wing table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans y No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o cy �g torg BatteryUnits Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection -and Initiatin2 Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Heat Pumpum Nber Tons KW No. of Self -Contained No. of Waste Dis osers P Totals: ............................ Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection EJ Other No. of Dryers Y Heating Appliances KW Security Systems:' No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No, of Devices or Equivalent Bathtubs No. Hydromassageent No. of Motors Total HP Telecommunications Wiring• No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the inspector of wires. Estimated Value of Electrical Work: (When required by municipal policy.) , Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury 1h at the information on this application is true and complete. FIRM NAME: — i JO ets CG,-� (-9` LIC. NO LO a� Licensee: b ggiX, � I k--�n t/��Signature LIC. NO.: (If applicable, enter `'exet" i the license number liy e.) i(�. us. Tel. No.: Address: �`f G S ( "� fO �l �' 0 r`f Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent 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 k _ permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed y 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 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass R Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS CTION: Pass M V/Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: el -4 !d FINAL INSPEC ION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department oflndustrialAccidents " d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Lidividual): )fie S C C& C(y\ Address: City/State/Zip: V •/4ti 1) (9 e�10 Phone #: "TF_ Irb Are you an employer? Check tlie appropriate box: Type of project (required): . 1.❑ I am a employer with employees (full and/or part time).* 7• ❑ New construction 2.n I am a sole proprietoror partnership and have no employees working for me in 8. ❑ Remodeling any capacity. [No workers' comp. insurance required] In I am a homeowner doing all work myself [No workers' compAnsurance required.] fi 9• Demolition 10 ❑ Building addition 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole 11. ❑ Electrical repairs or additions proprietors with no employees. 12: ❑ Plumbing repairs or additions 5. I am a general contractor and I have hired the sub -contractors listed on the attached sheet. ❑ # 13: �] Roof repairs These sub contractors have employees and have workers' comp. insurance. 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 14. ❑ Other 152, § 1(4), and we haveno..ergployees: [Np workers' comp. insurance required.] `Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must -attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have , employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. X ani an employer Aat is pi ovidiizg workers' compensation insurance for my employees.' Below is the policy and job site information. _ Insurance Company Name: /ll V,,,, /� ' CD Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: �3 e1.t_-d IFAI `�l City/State/Zip:. y' 4 levo` ( � Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido hereby certify under the '-andl-pemtltiQs o 'ury that the information provided above is true and correct. .Qivnai-nrr. \ \ _ bate' > �� 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 -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 Ihdustrial Accidents foi• 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Date ..... ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ..... .... Ms certifies that ............... ....................... has permission to perform ................. �) ....................... ............. wiring in the building of ........ . ............................................................. at............. _R3,5 ......... .................. North Andover, Mass. . ... .. ... .......... �41i.l ....... Feel ... ..... Lic. No. .2 .............. ... ?LE�2rRICAL 1&�SpEcrm L Check # 'f n b ; Caucmanuma�I s�l�%tt3�tu% Official Ou @al r '- �GJOfJnrilllOnG O�� �RliltC6j Pesmtt iYO. `-i=—..i_L J BOARD OF FIRE PREVENTION REGULATIONSOesupancy and Fee Checked ot"• 1/071 Heave hitm % APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WVOF All word to be pmforma:d in ac¢oHhu= with LIM Massaehu segs Eteetdcal Code (MEC), V7 CMR I? Olf (PLE&BPRINTINDZOR27PRALLBWOR1UTION1 Date: S— cg — %4 City or Town ok U e- (L To the inspector ofTimes: By this application the undersigned gives notice of his or her intention to rm the electrical work described below. Location (Street & Numberj g 3-5' G � -e &+ Nvi S OwnerorTeaant Owner's Address Sr. -enc CA. Telephone No. Is this penukin coajuMetion with a buflftgpamit? yes No ose ofBnitdia n El (Check ApproprinteBa�at) Purp B Utility Authorization No. s ti _ ng Service Amps / __ OIts New Service Amps t volts Number of Feetim and Ampocity Location and Nature of Proposed Electrical Work.. ofRemwed Luminaires of Lunduaire Outlets of Laaminaires of Receptacle outlets of Switcies of Ranges No. of Wnste Disposers No. of Dishwambers of Dryers to -Beaters ICVV $Yd[rnmassage Bathtubs Overhead ❑ Undgrd Overhead ❑ Uudgr d or Cen -5usp. (Paddle} Fans orHotTabs uta;nuingPooi'�0ve [� In - td. Enid. 131701 Burners of Gas Burners at -Air ConaL Told WArea Heating ICW sting Applianees xy or iVo. or Sfa=_nS 13= of Motors Tatnl HP No: of Meters No of meters > eraiors ICDA �uAits L7 g Z ALARM No. of Zones of Detection an Initiation Devices QfAlerting Devices 11mc= gni -- Cconnection b Other Estimated Value ofEtectrical Work; cp rtuach addlilotml detaff ijdesbnd oras required by[lieltzcpectar n - Work to Stam fnspectiatis to be re Idea �� by municipal policy ) --_.--.__._ _.INSURANCE C0.. quested in accardaace with MEC Rule 10, and upon completion. ..._...___�.___ vEIiAGT1:=Unless-tivnived-by-tbe�otivner; napa�mit=foe tile= e�armai��a - 1' the licensee provides proof of iosamt �. • g �omple>Pd p felt eti�cd VIM IfnbilkY mdttdias -nay ue undersigned cmaes thatsuch operation coverage or its substantiae eaauivalent CHECK ON&- INSURANCE Bt3M3 .iarc� and has exhibited proof ofsame is the penult issuing ofiece` J cer[ifj': under tits pains mrd o [] 01Z�R ❑ (Specify. FIRM fpe1*016 tttttt Aminfornuttrvn an dais applicatfott is tnte and wolptets. 'iieeasees 2 L ': C Cti *Per MIia oer6.Lle., cen.teammn Signature \ rprteirmnumb rpm) NNOO..:e 3qa oS-At K BusTeiNo - v�� 147, c a s. 57-6I, security vnorkrequires Department ofpublic Safe s I.i Alt. Tri. Nom OWNER'S INSURANCE WAIVER: I atm aware hatthe tY u " Lir. No. required by law. By my sigatathue below, I b Li�tasee does not have the liability insurance coverage n� OOwDer/Agent m'y wdve this r9quiremmL I am the (check one) Q owner ❑ Signature�yner's s Telephone No. PEI�VIIT FEE; -S I I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 W""kers' www.mass.gov/dia ompensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1pk. cvll Uket ty • t. Address: lye Gtt I SAMt. Vkt City/State/Zip0 (a Phone #: 77 1 ` a3 % - ;TJ 7 -i Are you an employer? Check the appropriate bog: 1. ®-1 am a employer with y1 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet sr p and have no epiployees These sub -contractors have ,%rK g `forme to dtlytpa acity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required] officers have exercised thew 3. ❑ I am a homeowner doing all work right of exemption per MGL i myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required`,_', 6. ❑ New construction 7. ❑ Remodeling I8. ❑ Demolition 9. [:]Building addition 10.X Electrical repairs or additions I 1.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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: CoMtrntr ca.. ins Policy # or Self -ins. Lic. #: 4 Mos;A1R I nt rj♦" 1LL Expiration Date:OC.J a3. 1 zo,,f— t1 Job Site Address: C3 S Cl, e sA-V� V �� City/State/Zip: 4� - f-� vj Ul1-e,, Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sip -nature: Date: �C Phone #• —M— Wit— i S7') Oficial 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 Location C-1 4 5/1- No..�Q 75-- 1,61, Date Check # 4�2/ 4(� TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $ 6136 #n� Inspector dp Cl 1 O J u=. 0 L u yi \ O LL a0.+ N N U U) (n O IL Z Z 0 J = m C O a, co 'O O LL L O K > N C L U C LL OO w CLW z Z m J d L O W O LL a o z Q V F- J W L O = V (n O 11 oc O a Z L OC C LL a 0. LLI LU LL L CO O Z 0 y_% d p O N 0 uj am `��•:�Q=N_�caVn+'. �V�'•�(�oO/1 � :.:��c•—�'QwyL��_o�Vo�a��y-s.o o;o EEL� J� n_- •O'QC_=3d >cU o c U E0 0Z � n O= o0 Q CL 0cc 0 NCM o L0 CL .2 ca O '2 UlC :EE N O F- w Q 00 CL m N of a� m L 0 _ '0 N a> t O Z O a J O G 2 Z O m Z W a W C� G W A N Renewal bYAMersen lilleamillis MA Home Improvement Cont Renewal b Andersen Corporation uoense #170810 (Expires 121231 �' Fedemi Tax lD #41-191 30 Forbes Fid. Northborough, MA 01532 (508) 351-2200 Fax (508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyer(s) Name Date., DIANNA GAUDET - RICHARD GAUDET JULY .16r 2015 Buyer(s) Street Address City State Tip Code 835 CHESTNUT ST. NORTH ANDOVER MA 1 01847 Email Address Home Telephone Number Work/Cell Telephone Number DIANNA.GAUDETQGMAIL.COM 978-857-8532 978-273-8337 Buyer(s) hereby jointly and severally agrees to purdfiase the goods and/or services of Renewal by Andersen Corporation {"Contractor"), :in aocordanoewith the terms and conditions described on the front and the reverse of this agreement and on the attached spedfication sheet(s) (collectively, this "Agreement). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement Est, Start Date Method of Ea3Ment Totes Job Amount ,$, 19,721 m rawww$ 12,721 ElChecklCesh Deposit Received (33%) $ 7,000.00 WPM at signing $ 6,360:50 $-ip weeks Balance Stan of Job (33°6) $ 0.00 Check s Balance on Substantial At sal Est. Install Time ❑ Credit Card Completion of Job (33%) $ 0.00 carnaeltlon $ 6,360.50 12 daySif cradle cared is selttl�ed, please No *W dW be demended a dl al are senened Kaes Credit Card form Buyer(a) agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there aro no verbal understandings changing or modifying any of the terms of this Agreement No alteration to or deviation from this Agreement will be valid without the signed, written consent of both Buyers) and Contractor. Buys4s) hereby acknowledges that Buyer(s)1) has read this Agreement, understands the terms of this Agreement, and has received a completed, signed and dated copy of this Agreement, including the two attached Notices of Cancellation, on Ube date first written above and 2) was orally informed of Buyers fight to cancel this Agreemimm L DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Anderson Corporation B r( Buyer(s) Signature of Consultant —Signature - — __ _slore__ x BRUCE PECK DIANNA GAUDET RICHARD GAUDET Printed Name of Consultant Primed Name Printed Name . YOU, THE a11YER(S), MAY CANCEI. THIS TRANSACTION AT ANY TWE PRIOR TO woNaff OF THE TNmD RUSINEW DAY AFTER THE DATE OF TNIS TRANSACTION. SEE THE ATTACKED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS t0O117. ----------------0---—i------------ rr.-r—r^r ^ — — —— N --------Lt--------------- NOTICE ON Due or Transaction 7/16/15 . You may camel this DateafTramaetios 7/is/ls , You maycasceld" ,ro-actt-4 widest any Penalty or obligation, within duce business days from the transaction, without any penalty or obligatien, wbtais three business days ansa the above date. If You cancel, say property wed in, say P -Y-- made by Yon reader I above date. It yes esoeel, any Property traded Iftony payments malt by im-under the Contract of Sale, mad say negotiable iastrameaR eaeemted by yen will be I the Cen&wtof Sebe, and asy negothNe Psstenmem esecued by you wM be returned within 10 days following receipt by the Contractor ("Seller") styew retursed within 10 days following receipt by tie Contractor ("SeNer") of your caseeaation notice, mod any secodty Interest arbda8 out of the traaaaedon will be I eaneellodoo notice, and any security interest arising an of the transad3os will'be canceled. It you cancel, you moat make available to the Seller at Vow residence, is I canceled. If you asset, you man make available to the Seiler st your residence, Is substantially as good condition as when received, any mods delivered to you and I ssbstandalty asGood condition as when reedved, any goods delivered to yeti seder this Cancract or Sale; or yon may, It yea wish, comply with the Instructions of the I this Contract or Wei or you may, it you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. I Seller regarding the return shipment at the goods at the seller's expense and sigh. If yon do male the goods available to the Seller and the Seller does act pide them ap I 'If you de make the goods available to the Seller and the Seller does not pith them up within 20 days of the date of your Notice of Cancellation, yen may retain or dispose I within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without say larther obligation. H you fmD to make the goods available I of the goods whhmd any further obNgadoo. It you fill to make the goods availahte to the Seam or It you agree to return the goods to the Seller sad fail to do as, then I to the Seiner, or H you agree to return the goods to the Seller acrd fall to do so, then you rennin Kahle for performaaee of an abligadom under the Contract. To eased yen remain liable fbr perhwm race of all oMigmio ma.the Contract. To cancel this transaction, mall or dgHver a signed and dated can of thin cancellation notice I this trsssactise, .mall or deliver a signed and dated copy of this easeeaofioa sotice or any other writtenasdeq ar send a telegram to Coatracten Renewal by Asdeeses I or any other written settee, or send a telegram to Contraeton Renewal by.Andewen, 30 Foebea Rd. Northborosg% MA01S32. I 30 Forbes Rd. Norshborusgh, MA 01532. 1 MERIMY COWELT1111% TRANSACTION. I 1 Homy CANCEL THIS TaANSAanaN. 1 ev/erosgntue P" sne Dee i OLVeftso-kre FAA tsuu Dale Renewal Renewal by Andersen Corporation MA Home Improvement Coriftetor byAndersen. 30 Forbes rd Northborough, MA 01532 License #170810 (Expires 12!2312015) wINORw RENnCER1ERT (508) 351-2200 Fax: (508}9867072 Federal ID #41-1818413 Window Specification Sheet Bu qs) Name Date of Agreement DIANNA GAUDET RICHARD GAUDET THU, JUL 16, 2015 The buyer(i) listed above hereby jointly and severally agree to purchase the goods and/or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which the Specification Sheet is part. WINDOW R DOOR DETAILS AM. APP. Apwr Exterarnnteria Cola Hardware Hardware lovrEa / snide G09 Glass Room Y width helgrx UA. Window/Doors Detail Ext -Int Color style Scrams Smrn rn Gilles seen U3 Saett2 Lifts options Din 101 32 60 92 DB rail 1 amt am L -Trim White Standard MFG ens GBG 412 0 No Din' 102 32 60 92 DB rail insert �I L -Trim H White Standard MFG t;BG 412 o No Din 103 32 60 92 DB rail equal Insert all L -Trim H White Standard MFG rtS OW 412 0 No Dining104 32 60 92 DB rail Insert all L -Trim H White Standard MFG GeG :412 0 No Kitchen 105 32 60 92 DB rail alinsen awl L -Trim H White Standard MFG s GeG 42 0 No Kitchen 106 32 60 92 DB roti insert sloped am L -Trim White Standard MFG arts ow 42 0 No Laundry107 32 60 92 DB rail Ytaert aid L -Trim H White standard MFG Goo 42 o No Bath 1 108 32 60 92 DB rail insect awl L -Trim White Standard MFG Gat o 0 No Family109 32 60 92 DB rail insert sir L -Trim White Staridard MFG arts GRG 42 0 No Family110 32 60 92 DB rail insert all L -Trim White Standard MFG Get 42 0 No Uving 111 32 60 92 DB rail insert MI L -Trim White Standard MFG Gas 42 0 No uv 112 32 60 92 DB rail insert sit L -Trim White Standard MFG caG 42 o No Uvin 113 32 60 92 DB rail insert all L -Trim H White Standard MFG an taG 42 o No Total 13 BAY. BOW & BUILD OUT DEMU Approx SlysDetail f Approx. Nxnber Frame Window End Center lnwE/ Rod/ Hardware Room Cant S Flenkera Caainp Lues interior giant Color finlbs sashes sashes Srreerhs' Smanstn Soffit Cola SPECIALTY WINDOW DETAILS F.111 Approx. —/ .. specialty BAY/BOW ADDITIONAL WORK NOTES Room Count a Insert Ui. Snortsm (3dlba Griwe ExtAnt Color Custmer is aware that with a y/hou, wrindnwa wrekr 22 hilus dare will be,kgnificant glass tore ADDITIONAL WORKDETAIISt Pitckpockoft I No Contractor will wrap exterior casings with coil stock color of 2 Owner is aware that Contractor does not do any painting/staking or removalfrnstelletion of alarm system or window treatrnents/hardwwo. It is Nhe responsibility of the homeowner to have the alarm system and window, treaMteruts/hardware removed prior to installationtb6 make no guarantee as to whetherahum or window treatments/hardware will rot after replacement Customer is also aware in some cases there will be glass loss. N there IS the amount will be dependent on the type of existing windows, type of installation and window style. ft make no guarantee as to the amount of glass I=. Customer is aware and understands any and all unseen ret is not included in this contract Should any rot be found there will be an additional charge for tree and materials unless so stated In this contract. I yes Contractor will Insulate, caulk and seal windows with 3 -point system to prevent water and air Infiltration. Removal and disposal of all job related debris, windows, doors, storm windows and vacuum nightly included. Upon completion of the job and payment in full, a limited warranty shall be Issued. 4 Yes Building Permit–Contractor will secure arry and all necessary permits. The fee for the permit(s) is included in the total contract price. s Yes All discounts have been applied to this agreement. 6 R Yen i:_) No Owner agrees to be presem on the final day of installation for final inspection and to deliver fatal payment/ finance torrrn(s). It is agreed and understood M• and between the parties that this Specification Sherr, along with the CUSTOM WINDOW AND DOOR RENiODFUNG AGREENIFRT, aanihutes the entire understanding betwern the parties, and there are: no verbal understandings changing or any of the leans. This Specfrcadon Shect may not he changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Bu)vr(s) and Contractor. Buyers) hrrrby acknouiedge that Buycr(s) has read this Specification Sheet. Renewal by Andersen Corporation Btn'et ja) Bnyer(a) Bmze me Signature of Consultant i9 Signature - - Signature 9 BRUCE PECK DIANNA GAUDET RICHARD GAUDET Print Name of Consultant Print Name Print Name dsenor awe.aOS M.E.C.C.E.C,ILE.CA:. Ai IMGlMba agdnaaatsMlCMAlYiw7kGRio.tb. Aeyoa. .. - � Renewal byAndersem NItiDOW REPUICt;I�EIIT ba/lndenatGw�A� ............... WootWitp►{ Composite IF Dual Argots - Loot E4 SntwMs m Double Htatg 100-00473518-010 PERFORMANCE RATINGS ENERGY U-Factor (U.SA-P Solar Heat Gain Coefficient 00*29� n!. ADDITIONAL PERFORMANCE RATINGS Visible Transmittat)ce On42e- abiawayPfea41.I1F71C pasaAnaaserdNaesieigvAds Padret Pa�baoaaos. Nt somp.andnamYWbra on dards.vioan.attloeaAYnrasdaapasicpoA�aatw NFpC dens oat aeaawaaaagpad."aW dow ON wmar Me tAmWYa-I PSG braaYaPaeie "• Coosa awaU%dW h Raman twee" *&a Paebnppq idaiarba. MfYYWJIfiEAIID Taapaa.a wars�3oaa�. f, uwnoovioosw" �* ga.dar�DevanLlY�9Y E'� a1t'M►rYas.talie '�`qa bma sae arA �. i"�'¢-•�„ � Cr� :� aos�a0awt6W DESIGN PRESSURE "Fj Mv a I OR' H-LC25 RbA DB Sloped Sill WIN -T'NIU lMOKAMlAA10lBtlC61H1AS6MIK UAMnrAfSaK mfOnenospM atrmrac dsenor awe.aOS M.E.C.C.E.C,ILE.CA:. Ai IMGlMba agdnaaatsMlCMAlYiw7kGRio.tb. Aeyoa. .. - � The Commonwealth of Massachusetts fn M Department of IndustrialAccidents Office oflnvestigadons ir 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lgdbly Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD NORTHBORO, MA 01532 Phone #: 508-351-2200 Are you an employer? Check the appropriate box: 1. Q 1 am a employer with 30 4. 1 am a general contractor and 1 employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp• insurance.$ required,] S. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. © Remodeling 8. ❑ Demolition 4. E] Building addition 10. F1 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contraaors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. I am an employer that Is providing workers' compensation insurance for my employee& Below is thepolicy and job site Information. Insurance Company Name: OLD REPUBLIC INS. CO. Policy # or Self -ins. Lic. 4. MWC 30293800 Expiration Date: 10/01/15 Job Site Address: 835 Chestnut St City/State/Zip:, North Andover, MA 01845 Attach s 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 ofthAD1A for insurance coverage verification. I do hereby cerdfylnder the pains and penalties of perjury that the information provided above is true and correct 9-2200 'T- P- -/ I — Offtial use only. Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other PermittUcense # 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector Contact Person: Phone #: ANDECOR-01 YADAVYO A�oRv CERTIFICATE OF LIABILITY INSURANCE n TYPE OF INSURANCE 101112014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED, the pollcy(les) 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 endorseme s . PRODUCER NAME: CONTACT certificatBs@wiilis.com Willis of Minnesota, Inc. c/o 26 Century Blvd PHONE8 945-7378 F No Exti: { 77) N.Y (888) 467-2378 ADDRESS: P.O. Box 305191 Nashville, TN 372305191 MED EXP (Any are person) S 10,001 INS{! AFFORDING COVERAGE NAIL / INSURER A:Old Republic Insurance Company 24147 GENERAL AGGREGATE S 4,000,0011 INSURED INSURER B: INSURER C: Renewal by Andersen Corporation INSURER D : 30 Forbes Road Northborough, MA 01532 INSURER E,. INSURER F : 1010112015 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRNSR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN POLICY NUMBER POLICY EFF POLICY EXP LJMiTS A X COhMAERCUIL GENERAL LIABILITY CLAIMS -MADE T OCCUR MWZY302940 10101f2014 1010112015 EACH OCCURRENCE S 1,000,0 PREMISES .1$ 500,0 MED EXP (Any are person) S 10,001 PERSONAL& ADV INJURY S 1,000,00 GEMLAGGREGATE LIMIT APPLIES PER: X POLICY 1:1JECaT [—]LOC OTHER GENERAL AGGREGATE S 4,000,0011 PRODUCTS-COMPOPAGG $ 4,000,0011 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS OWNED HIREDAUTOS ACOS MWTB302575 10101/2014 1010112015 C(EM=i SINGLE $ 5,000,00 BODILY INJURY (Per person) $ BODILY INJURY (PeracddenQ S a UMBRELLA WB EXCESS LIAS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION S A WORKERS COMPENSATIONX10 AND EMPLOYERS` LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE F N OFFICERIMEMBEREXCLUDED? NNIA (Myaenftory In NH) UrKlOr DESCRI� 0OFOPERATIONSbelow MWC30293800 10/0112014 1010112015 STATUTE ER E.L EACH ACCIDENT $ 1,000,00 E.L.DISEASE - EA EMPLOYE $ 110001 E.LDISEASE - POLICY LIMIT S 1100010 DESCRIPTION OF OPERATIONS J LOCATIONS I VEHICLES (ACORD 101, AddkkmW Remarks Sdwduie, may be sued" ff more space Is required) CERTIFICATE HOLDER CANCELLATION ACORD 26 (2014101) ®1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOREM REPRESENTATIVE 01 Evidence of Insurance ACORD 26 (2014101) ®1988.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P 0 In n Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supersisor License: 25 JABS L MORIN- �� 86 GARDINER ST �?' • dG% 1', LYNN MA 01"f l f �r..)1-14k►' Expiration Commissioner 10/06/2016 •.,_ t-�iis rpo�vmansoealQ� o��!�aaiuvek'1 ffice of Coassmer Affairs & Basiness Regulation i DME %WROVEMENT CONTRACTOR ReO tttbn: 170814) Type; Expiration: 11,21=15 Supplement I t RENEWAL BY ANDERIW_.,COtPORATlON LE JAIME MORIN 104 OTIS STREET NORTHBOROUGH, MA 01532 Undersecretary I 0 e BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Z / Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION F36- (-1 p S'A`N sv Wo �r`�'���'�-�7 a" NORTFj 0 Print PROPERTY OWNER (94 ,04 L"�e-l- Print 100 Year Structure yes no MAP /PARCEL: 00d-& ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial 44 R pair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer - -- - -- --- DESCRIPTION OF WO K TO BE PEKFUKMEU: IV 0 Identification - Please Type or Print Clearly 4'7a, -7,7S %J`V 7t OWNER: Name: / Ai✓1�q GaµdP� Phone: 40 1 If Address: �s Contractor Name: ��'�'� %%��n/ Phone: 617— % Address: r Supervisor's Construction License: 09r1A Exp. Date:_ Home Improvement License: / 7D ?/0 Exp. Date ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ l9 %, /, 90 FEE: $ 6�1-37• Dv Check No.: �32 l Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access guaranty fund Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application ;aF Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) :rF Engineering Affidavits for Engineered products TOTE: 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 ofBuilding Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic C9Iculations (If Applicable) Copy of Contract 2012 IECC Energy code .� Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 SLocation No. Lp6q— C,65—��,4 os—�� Date Check # LZ uko �. �,# - � J 2 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $-. Foundation Permit Fee Other Permit Fee TOTAL $ (?—� AL—C Building Inspector TOWN OF NORTH ANDOVER 1 APPLICATION FOR PLAN EXAMINATIO Permit N0: I Date Received Date RTANT: Applicant must complete all items on this LOCATION _S Cl�,�.s �-��` S�'+V•�-"� _ _ PROPERTY OWNER TZ � CL, Print 100 Year Old Structure MAP NO: PARCEAZ ZONING DISTRICT: Historic District / Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building EgOne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic, ❑ Well p Floodplain ❑ Wetlands ❑ Watershed District' Water/Sewer lDESCRIPTION OF WORK TO?E PERFORMED: 3 S h 2o� 0L n,w..e r- O� �t P r 0 eyus Identification Please Type or Print Clearly) OWNER: Name: 9c -,A -Q --t- Phone:gl t - Address: CONTRACTOR Name: 4v— Phone: CSB $ 5L3i-3-5- E t - mss: Q � rvisor's Construction License: Exp. Date: i Improvement License: Wt b "1`1 Exp. Date: bV-zg L 157 ARCHITECT/ENGINEER 3�-� lt-r` Phone: e, --i5- - b%1-` 15-2 Address: '499 ti � A -, Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ S\ ,32 O FEE: Check No.: 7i1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si j, nature of contractor Signature -of Agerit/Ownerl ; g _ _ . _ Plans Submitted -1 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plan Building Department The folowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofh'ig, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application Li Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses E, Copy Of Contract E3 Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) L3 Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appz al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buiiding Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 519300.0.0 m $ - $ 615.60 Plumbing Fee $ 76.95 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 76.95 Total fees collected $ 869.50 835 Chestnut Street 659-14 on 3/26/2014 Shed Dormer ACCMV CERTIFICATE OF LIABILITY INSURANCE NYYY DATE 7/17/2013 i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 M P ROBERTS INS AGCY INC 1060 Osgood Street North Andover, MA 01845 CONTACT NAME: PHONE -g78) 683-8073 978) 683-3147 AIC No Ext : A1C, No : I- olEss:sandi@mprobertsinsurance.com ( BOPI068945 11/22/12 [NsuRERtsI aeFORo[s!c covERAce [oats INSURER A: PROVIDENCE. MUTUAL A AG PREMISES Ea occurrence $ 500,000 INSURED KEVIN MURPHY BUILDING & REMODELING INSURER B: MERCHANTS INSURANCE 169 BOXFORD STREET INSURER C: GUARD INSURANCE NORTH ANDOVER, MA 01845 INSURER D: INSURER E : B INSURER F: LIABILITY ANYAUTO ALL OWNEDX ' SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COVERAGES CERTIFICATE NUMBER_ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I LTR TYPE OF INSURANCE AD DL INSR SUER WUD POLICY NUMBER P LIGY EFF MMIDD POLI Y EXP MMIDDIYYYY LIMITS A X COMMERCUU. GENERAL 114BI1.ITY CLAIMS -MADE ® OCCUR ( BOPI068945 11/22/12 11/22/13 .EACH OCCURRENCE S 1,000,000 A AG PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 15,000 PERSONAL &ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER POLICY F-1 PRO iJ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANYAUTO ALL OWNEDX ' SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS MCA7013608 01/23/13 01/23/14 COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 BODILY INJURY (Per person) y $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B UMBRELLA LIAROCCUR EXCESS UABHCLAIMS4AADE CUP9145304 11/22/12 11/22/13 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYEP.S' LIABILITY YIN ANY PROPRIErORIPARTNERIDECUnVE (endory)°cC11DEDi fn NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below i NIA KEWC422467 07/01/13 07/01/14 PER X STATUTE ER E.L. EACH ACCIDENT $ 500 ,000 EL DISEASE - EA EMPLOYEJ $ 500,000 E.L. DISEASE -POLICY LIMB e 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) TOWN OF NORTH ANDOVER BUILDING DEPT. NORTH ANDOVER MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRES A tg I U&S-2U'I 3 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 600 Washington Street Boston, MA 02111 www.nws gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):��-�� Address: S City/State/Zip:1../ o t �l� Phone #: 4.1 45- � S1 `5 3 3 Are you an employer? Check the appropriate box: Type of project (required): 1:6 I am a employer with ` 4. ❑ I am a general contractor and I 6. E] New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner -7. have hired the sub -contractors listed on the attached sheet. � emodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,ORoof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill outthe section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they ate 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 for my employees Below is the policy and job site information. Insurance CompanyName:. J -+"s c Policy # or Self ins. Lie. #: `L�E wL Ll'C-Z- �l `� Expiration Date: `1 L Job Site Address: �i 3� L — S ` City/State/Zip: N, . 6-J-1 t 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido herebylcerto under the pains and penalties ofperjury that the information provided labove is true and correc4 Date: V 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 #: 98 Forest Street (evu • North Andover, MA 01845 1_ril n • ,- PH: 978-688-5335 Building Contractor FAX: 978-688-7207 Proposal To: Rick & Diana Gaudet 835 Chestnut Street North Andover, Ma. 01845 From: Kevin Murphy CC. Date: 3/10/2014 Job: Shed Dormer Date of plans: 10/13 Architect: Steve Foster Location: Same Section 1- Work Schedule All Home improvement Contractors and Subcontractors engaged in hone improvement contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, must be registered with the Conmorwealth of Massachusetts. Inquiries about registration and Status should be made to the Director, Hone Improvernent Contrail Registration, One Ashburton Place, Room 1301, Boston, MA 02108. (617)-727 8598 Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 4/14/14. Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 6/15/14. The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section 11- Warranty The Contractor warrants that the work fumished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section III — Scope of Work Page 1 of 4 ., 2 Kevin Murphy Building Contractor 98 Forest Sheet North Andover, MA 01845 PH: 978688533.5 FAX 978588-7207 Page 2 of 4 General Proposal is to build three quarter shed dormer on rear of existing house, as shown on owner's plans. Building permit will be obtained by contractor. Building plans and any structural engineering to be provided by owner. Demolition Existing second floor bathroom will be completely gutted. Two existing bedrooms will be gutted as required. Building All frame , roof, and siding materials will be supplied and installed to match existing / as shown on plans / to meet code. Existing floor structure to remain. Exterior walls will be 2x6, roof rafters will be 2x12, ceiling joists will be 2x10. All floor, wall, and roof sheathing will be fir plywood ( 3/4 on floor, 1/2 on walls, 5/8 on roof ) . Ice and water sheild will be installed on all roof edges. Roof shingles to match existing. Exterior walls will be wrapped with Tyvek or equivalent. Vinyl siding to match existing. Four Harvey all vinyl doublehung windows will be supplied and installed as shown on plan / to match existing. Interior petitions will be 2x4. Columns / footing will be installed in existing basement. Plumbing Plumbing required to provide new three fixture bath will be provided. Owner to provide plumbing fixturres. Electrical Electrical work required to wire second floor to code will be provided. No allowance has been made to upgrade existing electrical service. Any surface mounted fixtures ( ceiling fans, vanity lights ) to be supplied by owner / installed by contractor. Phone / cable / computer lines to be roughed in by electrician, to be connected by service provider at owner's expense. General layout to be approved by owner, prior to rough. Heating/Air Conditioning Existing heat will be relocated / added as required. No allowance has been made for any air conditioning. Insulation Added / renovated areas will have fiberglass insulation installed to meet code. Plaster Two bedrooms and bath will be blueboarded and skimcoat plastered. Walls will be smooth, ceilings to match existing. Interior Trim/Doors Pre -primed interior trim will be supplied and installed to match existing. Bath vanity / countertop to be supplied by owner. Flooring Tile floor will be provided in bathroom. An allowance of $6 per square foot has been included for tile materials. No allowance has been made for any carpets / flooring in bedrooms. Kevin Murphy Building Contractor 98 Forest Street North Ardover, MA 01845 PH: 978888,5335 FAX 97888&7207 No allowance has been made for any painting. Waste Removal All demolition / construction debris will be disposed of by contractor. Page 3 of 4 Kevin Murphy Building Contractor 98 Forest Street Nath Andover, MA 01845 PH: 978688-5335 FAX 978688-7207 Section IV - Price Schedule Total Page 4 of 4 We hereby propose to furnish material and labor — complete in Accordance with above specifications for the sum of ..................................... $511300 Payment to be made as follows: Percenta alItem Description Amount 1 Permit obtained $3300 2 Demolition complete $5000 3 Roof framing complete $15,000 4 Sididn / windows installed $10,000 5 Plastering complete $101000 6 Trim /tile complete $5000 7 Job 100% complete $3000 7 $511300.00_ -Notice: No agreement far Home improvement contracting work shall require a dam payment (advance deposit) of more that aye -third of the total contract trice of the total amamt of all deposits or payments which the contractor must make, in advance, to order ardor otherwise obtain delivery of special order materials and equipment, whichever is greater Contractor: Kevin Murphy 98 Forest Street No. Andover, MA 01845 Registration No: 101874 Section V - Acceptance Acceptance of Proposal — I have read this document and accept the prices, specifications, and conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signatu- c",'--� Date 3 1 Zai I I "-/ Signature Date J0 LU U. C 0 m C 41 u Y O 0 LL E v N u O. (UC ( /) C Q. z (7 Z m O a 7 LL s z d' ai c U LL O d Z Z J d C M d' LL 0 C. Z Q U H LiJ L J s 7 CC v u_ .� In LL 0 w CL Z Q on 7 d' r0 LL Z LU 5 � W W LL i m Z N N +� O N U y AW Q=••. 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X f— w Location P3,57 C11e0j'12; No. Date Ir'2 'joRTPI TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ "us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I/'? - 206 Building Inspector BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued:_1�' IMPORTANT: Applicant must complete all items on this naize y Sttev <6• ryO of o LOCATION h`p zilr1 }� l Nov-� Ani r\ MA Print ©1 PROPERTY OWNEFDM" Ir) JRbS7S 1 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration ll�No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Narne Phone: Address: 'T Supervisor's Construction License. Exp. Date: Home Improvement License: Exq. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $�� C7 C7 FEE: $ 50' — Check No.: .. Receipt No.: C96 9 - NO TE: - NOTE: Persons contrating with unregistered contractors do not have access to the guaranty fund signature of Agent/Ownignature of contractor Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 The Commonwealth of Massachusetts Department of Industrial Accidents " Office of Investigations d 600 Washington Street Boston, MA 02111 M S www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual):,,�—) Ian nc._ Address: 0 i13N.1� City/State/Zip: y.\ �N r Ooy W M` , Phone.#: T E� 9-7 S - Are you an employer? Check the appropriate bog: 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. I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised. their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reduired.l Type of project (required)':., 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building. addition 10..❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this aff davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure. to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above1 is true and correct Signature— Date: I 1 i 1 C-5 _ Phone #: City or Town: not write in this area, to be completed by city or town official, 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 "ever 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(!) 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 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 permittlicense 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 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. # 617-7274900 ext.406 or 1-877-MASSAFE ` Fax # 617-727-7749 Revised 11-.22-06 www.mass.gov/dia Breckwell Big "E" Wood Pellet Stove Furnace Pagel of 2 Pellet Stove - Wood Pellet Stoves By Breckwell Home > Free Standing Breckwell Big"E" SKU BigE iRRSNF TMI�� PfiGE. �EMriIL TFII� Gh,%,GE Pellet Furnace Home Heater Pellet Stove Type: Wood pellet stove Shipping: All pellet stoves ship from Tax FREE N.H. Shipping costs range from $100.00 to $300.00 depending on your zone (you will be contacted to confirm). Items can also be picked up at our Merrimack, N.H. Warehouse Pellet Stove Images: Many images have optional items shown. Usually the trim, log sets and brick backgrounds. These items are optional. Remote Control c No Remote C Add Remote Kit +$159.00 View Remote Control Hopper Option 0 No Added Hopper r' Larger Hopper Option +$149.00 Quantity _r�. DDi tTj3)';GfR,�Ty'71 Breckwell's BIG E utility and home heater bring together ECONOMY, EFFICIENCY, and EASE of operation. ECONOMICAL - When you compare the features and options you get with THE BIG E to similarly priced stoves you will see real value in this newest entry in the Breckwell line. THE BIG E brings to you all of the Breckwell reliability and craftsmanship at a very affordable price. EFFICIENT - Whether you're operating your stove at its highest setting or heating at its lowest level it conserves pellet usage. EASY TO USE - THE BIG E is operated with its digital one -touch control pad. No further adjustments are necessary. ECONOMICAL TO BUY -EFFICIENT TO OPERATE -EASY TO USE TURES and OPTIONS: . "Hot Rod" Automatic Firestarter . Heat up to 2,200 square feet . Digital one -touch control with diagnostics PECIFICATIONS: . Width:25 3/4" . Height:32 5/8" . Depth:23 7/8" . Weight:275lbs. http://www.pelletking.com/Breckwell-BigE-Pellet-Burning-Fumace.aspx 12/11/2007 y m m m x CA mm 2 y d CD C � O c) Z y CFD O 'O. CL r. c = ? o CL= Co cl CD o p ccoCL o c� =r %< CD CD O C CD CCDO) �. CLO CO) C I S p CO) O 'O Z CD O CD 0 CD �' W— F C c? -p =r --4 C H o Q co) to EL' � m CO) FL n O O y cD a C, m Z •m slo H -4 IM so CA �. CL a offin m y -4O ti p Zq N o gym: oCD 2>4 = O OZy'C.) ��•.•.��.•y� . C 1•, C = y d Qpm O O go _co - a m N V O d C y . N � Q CL H C � ^ � m ti '1 co, y : O H CA W m o '� J / GJ OCA o z a Or o i �� CD,...a`1i CD m f I. r ^ CD cn CCA f CD s W • ** C d. . o 'fl a �+ Cl) p 0 pot cD 1 C-3 � m 0 O `�° w71 G W 100 C~ w 0 C: Com" to y C C b �• O �ja�+ d n y GO b r7l C r7 O M 1 f b )Nq 0 9 0 P=h i47 O C Breckwell Big "E" Wood Pellet Stove Furnace . Up to 55,000 BTU heat input . 13 tube heat exchange system . up to 1401b. hopper capacity . 81 % fuel efficiency . Two thermostat modes:high/lo) or on/off . Five heat settings . Low speed trim setting . Limited five-year warranty . Optional radio frequency remote control . Optional 2101b. hopper extension . EPA exempt Customer Reviews . Flue Size:3" or 4" . Hopper Capacity: Up to 140lbs. (this can vary widely depending on pellet size, lenght and diameter.) . EPA Status: exempt . BTU Range: 8,200-55,00 . Approved Installations: mobile home, conventional Page 2 of 2 Average Rating bili 666t This model isn't as pretty as the one in our fireplace, but boy does this pellet stove put out the heat. - Shawn in Taledo, OH View All 1 Reviews Write A Review ©1998-2007 - PelletKing.com / SpasEtc.com a;�00�0O�C� http://www.pelletking.com/Breckwell-BigE-Pellet-Burning-Fumace.aspx 12/11/2007 Location No. 1`41- 7 Date 40RT" TOWN OF NORTH ANDOVER Certificate of Occupancy P *Ana Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20526 1261ding inspector 1� And Bldg Permit prinkler Plan And of Bldg Permit the Board of Appeals recision from and proof of recording ds. One copy — BUILDING PERMIT OF NORTH ANDOVER TOWN N FOR PLAN EXAMINATION PPLICA A Date Received 4 ... ORK TO BE PREFORM DESCRIPTION OF W TvDe or Print Clearly) roteaent .forme Irr'tp. - Phone: ARCHITECTIENGINEER Reg No.-', Address: E TOTAL ESTIMATED COST BASED ON $125.00 PER,S.F. SCHEDULE: BOLDING PERMIT: $12.00 PES $1000.00 OF THE FEE: $ FEES , i Project Cost: $ i�Q Total Prof ` Receipt No •: uarantyfund .e istered contractors do not have access tot e g Check No.: with unl g w Persons conte^acting trac#or Persi jnatue of c� NOTE: Plans Submitted ❑ Plans Waived ❑ TYPE OF SEWERAGE DISPOSAL P Certified Plot Plan ❑ ubhc Sewer 0 Well Tanning/Massage/Bod ❑ Y Art ❑ Swm1n11n Private (septic tank Tobacco Sales g Pools etc. � ❑ Permanent Dempster o Food pa,, n Site 0 Stamped Plan FOLLOWING btiat�ea. ` e° THE ' ti �;t�<°b iNTERDEp NG SEr aI t110 `atepe< ARTMr' i Oen' o0 PLANNING �``d��� �{o<,�reaP &-DEVELOP►Mr" v COMMENTS_ �eko Qe< Qett� .1e6 ko .01M 00 °{ ire teQ �era� P,�`�'e� ��a0Ge ;£ '0011 fi� x {o{e re SN 1 Pda� Qepep1 . P p06 o e ��\<efoa��SGOV�0 HEALTh COMMENTS ge°�as�� 09 ��G�ss'l o90°kvo ' kG� ok \eOP \e1 GoeQJ F�oo�eQ�e S�°� ses °�* ` o�� dump peon ���Ga <Q�a� �\Ge� edgy e� P 0� ,� pp Quo �,. OS 0 �a \40,��. Zoning Board of Appeals: Va Planning Board Decision: Conservation Decision: Water $ SeWer Connection/Si na ! ocated at 384 Osgood Street t ..' Mr-lYT TemP Du 'Main Street mend signature/date °o 0 eS& e,a G a koON Ped� pk�o a`,fie) s���G\SQ" ���yGa� °06e e° Xpe�ais c�a��QGl,�e �,o,,e .0PPaP\eve o�°o��o�S QrpGGeGod O cog, Go GaG�eo .k\cvkot g \ o� O° �\o a�eNMec, �NdaQ\Ytes` oFa �de� taco ee,�x�g wee�o-) to `e aid \° ti P �0G°r� Q e0 osed d G S O�`e� �e) o� \o �e� o' Q�°'P P�` • daJ��. �s � aa G<e t` •�� d G • �` �a 'P i— -- o° g°O e° �-1°,��eo ��,\ ��P�Q\� \P�p G�6110ff,o, • �0ode\� Ge\: edGmo� Qr°�Q�eOva\a1`eeF eVe�0� $so*' uesS GadG G°��a \ J0 \�`G tbe Go��S y\I6%�sr eae ��ie e�°�S`ee°t Gd9 S G,o'\�� P, s teQze(e e�Lvn o has , ee� e��` t�,�s� 1%51L xQ�QV��`e�ell t\°r �p'1 Fo rceXAO gQc� VV eat -S GESO�e VN aA aVV Ott 'L vVe 0 L01%.4 e ` ksvl Go`�� cJ`SQJ �, i BUILDING PERMIT NoeTH� o ,�t..eo TOWN OF NORTH ANDOVER � o i .. APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received SSACHUS� Date Issued: 23 0 IMPORTANT Applicant must complete all items on this page s. 4.1...,' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building .One family 11 Addition [I Two or more family ❑Industrial Alteration No. of units: 0 Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other DESCRIPTION OF WORK i U bt t'Kt1-UK1V1tu: W(MO byt'v�y-u ---51 C>\�k Identification Please Type or Print Clearly) OWNER: Name�la r,,na. Phone: �� ARCHITECT/ENGINEER Address: Phone: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 00 Total Project Cost: $ � I b 0 o •.1—'S FEE: $ �,:F� Check No.: 1 I/I Receipt No.: 0 a NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund nature of contractor71 Scgnature of Agenf0�rvne;r'. g_ . . Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract - o 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 N 0 M V) 0% E***", w O ? v o E a � z A C xw O CO a 0 U U W X00 w°' cn _ w pG w � `n .•c°0 m w Z A v w ca ° z cn Q O cn ui z am .mss x G � w O y G O ca CJ 3 ma 0 c (� Com: m o a E= m o M U0 z is X.O �1 O c `y y U . y �.ry 3 co •L c E m R (� m o 0 L` a� o Cn CD ID c o Q w t1 o o = m P-4 : IS SO : C Ha =O y m G •O m ;m4-3 N CL. o � o W ea 'OCIO m "' •C'm a=-. o C Z U= Q o o y O m w o C COD CD a g = A ai N 0 O Ar co O� ai ■ L O z a O CO) p c I a) cm O•— CO) p-0 .CO2 O O g m m CD CD CL ~_ CD O� � p o Cc O d a, cma ca 00= C !c O d O •�+ C z CD V ca O C — C _c C. CO3 p 0 W W ul w 0 TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Fax (978) 688-9542 Inspector of Buildings HOMEOWNER LICENSE EXEMPTION Pleaw gdA DATE: SIa3io4 JOB LOCATION b3-5 , W, Ani✓' 10'1- C [ a4o Number Street Address — — ---- Map/Lot HOMEOWNERS i cmn U0.- `� �-� -s LQ q"� 8 Name Home Phone Work Phone qB3 O pSiC �br" �N S3 C0IOn }� S PRESENT MAILING ADDRESS 8-26 City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to 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 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 or two family muchues. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that helshe understands the Town of North Andover Building Department minimum inspection procedures and mquirenients and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE �� APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption BOARD OF \PPEALS 688-95 11 CONS.ER\'.1FION 688-9530 11E.1L•fH 688-9540 PL.INNING ti88-9535 1600 MODEL INSERT OWNER'S INSTRUCTION MANUAL READ,ALL INSTRUCTIONS BEFORE INSTALLING OR OPERATING THIS UNIT SAYE THESE INSTRUCTIONS SEE BAFFLE AND BRICK INSTALLATION INSTRUCTIONS BEFORE OPERATING i Warnock Hersey .'r.�.' GAS &VVUOD cm memus HFAR Fil SYS I F .N ti Made in Canada 6NO023 11/17/01 WARNOCK MERSEY LISTED FACTORY BUILT FIREPLACE ACCESSORY INSERT CERTIFIED FOR USE IN CANADA AND U.S.A. MODEL 1600 INSERT ® TESTED TO ULCS628 RELEVANT ICBG # NER 219 REPORT NO. 5723 TIONS UNE 89) UL1482 INSTALL AND USE ONLY IN ACCORDANCE WITH THE MANUFACTURER'S INSTALLATION AND OPERATING INSTRUCTIONS. INSTALL ONLY IN MASONRY FIREPLACES. DO NOT REMOVE BRICKS OR MORTAR FROM MASONRY FIREPLACE. CONTACT LOCAL BUILDING OR FIRE OFFICIALS ABOUT RESTRICTIONS AND INSTALLATION INSPECTION IN YOUR AREA. BF -1 MINIMUM CLEARANCE TO COMBUSTIBLES (MEASURED FROM INSERT BODY) ADJACENT SIDEWALL A 405 MM (16 IN.) MANTLE B 560 MM (221N.) TOP FACING C 395 MM (15.51N.) CLEARA;.CE TO COMBUSTIBLE SIDE FACING D 255 MM (101N.) CONSTRUCTION INSTALL ONLY ON A NON-COMBUSTIBLE HEARTH RAISED 75 MM (3 IN.) ABOVE ADJACENT COMBUSTIBLE FLOOR UNLESS FLOOR IS PROTECTED BY UL LISTED "HEATSAFE HEARTH SHIELD" FLOOR PROTECTOR. FLOOR PROTECTION MUST EXTEND (E) 455 MM (18 IN.) TO THE FRONT AND (F)150 MM (6 IN.) TO THE SIDES OF THE UNIT COMPONENTS REQUIRED FOR INSTALLATION: POSITIVE FLUE CONNECTION. OPTIONAL COMPONENTS: FAN. FOR USE WITH SOUD WOOD FUEL ONLY. DO NOT USE GRATE OR ELEVATE FIRE. BUIL) WOOD FIRE DIRECTLY ON HEARTH. OPERATE WITH FEED DOOR CLOSED. OPEN TO FEED FIRE ONLY POWER SUPPLY CORD ROUTING: DO NOT ROUTE CORD BENEATH OR DIRECTLY IN FRONT OF HEATER. ELECTRICAL RATING: VOLTS: 1C AMP: 1.0; HERTZ: 60. REPLACE GLASS ONLY WITH CERAMIC GLASS. INSPECT AND CLEAN CHIMNEY FREQUENTLY. UNDER CERTAIN CONDITIONS OF USE, CREOSOTE BUILDUP MAY OCCUR RAPIDLY. DO NOT OVERFIRE. IF INSERT GLOWS OVERFIRING. YOU ARE GAS & "A(W MANUFACTURED BY OSBURN MANUFACTURING INC. 6670 BUTLER CRES. SAANICHTON, B.C. V8M 2138 HL29 WD MADE IN CANADA DATE OF MANUFACTURE U.S. ENVIRONMENT PROTECTION AGENCY JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC CERTIFIED TO COMPLY WITH JULY 1994 PARTICULATE EMISSIONS STANDARDS -:119921199311994[19951199611997119981199912000 2001 2002 Location -( N o. i Date 4�zao tOftTh .1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 8 —� �- 4 4.6 1 &- � (I q- - Building Inspector pORT" ° p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �1SS^CHUS�t Permit NO: Date Received: Date Issued:�%r IMPORTANT: Applicant must complete all items on this page LOCATION 5.35 cbiz6,. J'4� Is), -AN haKr Print PROPERTY Print MAP NO.:✓/6 � PARCEL.A z rcvr !1T TiTii i►71�T!' ZONING DISTRICT: u7MTnRif nlgTRIC..T YES ❑ 1 iIrE AN USE Ula DUiLlJil\V - ---"- -- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition Two or more family ❑Industrial ❑ Alteration No. of units: ❑ Assessory Bldg X Repair replacement ❑ Commercial ❑ Demolition ❑ Moving (relocation) ❑ Other X, Others: ❑ Foundation only Identification Please Type or Print Clearly) OWNER: Name: : c ► g� � 0ejnS'� A- Phone t�i8 857 ' �53� � - CONTRACTOR Name:Chi-�+� Phone: 07g =R' i_r S8"82 - Address: S2 a 12QPZVc _ � Supervisor's Construction License: Exp. Date: Home Improvement License: \376.0 -7 Exp. Date: i --I. 11-7 IaO v ARC HITECT/ENG[NEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. T&O' Project Cost :$ :7-.3t1' , QO x10.00=FEE:$ Check No.:- f'`�k_ Receipt No.: 9 -Ij Page Iof4 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENIAPFORN105 Page 4 of 4 13'7-'*' 2.2 i" 2 . . . . . . . 27" 54" aly 65," 24" 24" 30" 24" 9" W2430 WA24' A PiPCS for sink will have to go thr ugh bb c6iniet 15 Ifi-B30BUTTI 24.DISHW B9iR EZR43,kVVSS .. ...... ......... ---- ---- .. ... ...... . CO 0 W 0 N) C N 0 41 T U_ downdraft vent to be taken out C N J� ....................... /1,11 almensions -size designations given are subject to verification on job site and UdJUStillent to fit job conditions. This is an original design and must not be Designed: 4/30/06 released or copied unless applicable fee has Printed: 4,30/06 been paid or job order placed. ----- 41 00c41 a,kit Fp 1 847 1 1 a€ 30" 30r, /� I W3012 WA2430 I W3030BUT EZR33R.WSS I BD21 All dimensions -Size designations given are subject to verification on job site and adjustment to fit job conditions. asn MW.HOOD i I 21 ,I 69" tri—r "j / This is an original design and must not be Designed: 4/30/06 ; released or copied unless applicable Fee has Printed: 4.'30/06 been paid or job order placed. -- - Ela I I 38= 15" 27" 15" j=-- 24" — CO W2718 T_ W153 W153 WA2430L \ UCS27 i 0 ro � 36REF-3D r -- LO B18L.F BOWB18 B18 .FH R.FWT I i I 38lit� 18" ' I 18" ' I 18" 27" 85� — All dimensions -size designations given are subject to verification on job site and adjustment to tit job conditions. 4100e41 a. kit This is an original design and must not be — Desi ned: 4 +u ii( released or copied unless applicable fee has Printed: 4.:30.'00 been paid or job order placed. EI –.-- -i Drawin : I 137-r"" 24" 65711 2411 24" , | ! V7251 1 T_ ! , � Gp CO w n . no —�— | � --------------� -------------------'------� — -- � � V) | -- 417" 30" 2401 33" '| '� " " 28 " 54" All dimensions -size designations given are su b Ject to verification on job site and ULIjUSt111C11t to fttjob conditions. This is an original design and mLi ". t not be D signed: 4/30/06 released or copied unle." applicable fee has Printed., 4/30/06 1 been paid orjob order placed. � ^~- .~^~".'-,.:. � ROOFING CONTRACT U.S. Roofing a division of Building Maintenance Corp. P.O. Box 3118 Peabody, MA 01961-3118 Telephone: (978) 532-6300 Fax: (978) 977-0803 The Owner(s) of the premises described below, hereinafter Job Address, hereby contract with and authorize U.S. Roofing, hereinafter Contractor, to furnish all necessary materials, supplies, labor and workmanship, and to install, construct, and place improvements at the said Job Address, according to the following specifications, terms, and conditions: Owner's Name: Job Address: Job Specifications: Dianne Deossie 835 Chestnut St. Andover MA, 01810 835 Chestnut St. Andover MA, 01810 - Remove all existing shingle layers down to exposed roof board's - Dispose of all debris in a legal landfill - Install Ice and Water Shield at all gutter edges, valleys and all roof penetration. - Nail 15 -Ib. Roofing felt over entire roof surface. - Install 8" White aluminum drip edge to entire perimeter - Cut away. opening in ridge boards (to allow ventilation) - Install Certainteedt' 30 -year Architectural shingles to entire roof surface; storm nailing each (six nails per shingle) - Flash all roof penetrations according to National Roofing Standards - Install coil ridge vent at roof peaks - Cap ridge vent with Certainteedtm 30 -year cap shingles Please Note: - Any rotted board replacement cost (if needed) will be an additional $4.50/sq. ft. - Each additional layer of shingles over two layers will be an additional charge of $1.50/sq. ft. - Since attic and storage space may experience dust and/or debris during roof removal, it is the responsibility of the homeowner to remove and/or cover items contained within COST OF WORK: $ 7,391.00 U.S. Roofing a division of Building Maintenance Corp. P.O. Box 3118 Peabody, MA 01961-3118 Telephone: (978) 532-6300 Fax: (978) 977-0803 Terms: 50% due upon delivery of materials and commencement of work; 50% due upon completion of all roof work Contractor agrees to perform the above-described services in a good and workmanlike manner. This contract constitutes the entire agreement between the parties, and Owner agrees that Contractor has made no statements, promises, commitments or representations not contained herein. It is expressly understood and agreed that additional charges will be made by Contractor for all work, if any, ordered by Owner and not specified in this contract. Contractor is not liable for strikes, accidents, acts of God, or delays beyond Contractor's control. IN WITNESS WHEREOF, the parties have signed their names hereto: U.S. Roofir>6 a division of Building Mainte ce Corp. By: Homeowner m co m c D ;a- F O C O D A D o O 2 co M o Z Z n m -o 0 0 b 3 m*mc 00 OX- < C) OZ Z D Z n m n TN y a m a � y a H Q. A a m �a s; cr v� RH ❑ a to A CL O r"t °o CD yLn bd CD CD O CD � O i O � 0 M a m CD n O • 00 r•r W RCDP O � -4^ rn co 00 0 II 0 O Rill/ MAI -n1 MFNA A CORDrM C E RT I F I CAT E OF LIABILITY I N S U RAN C EDATE (MM/DD/YYYY) MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 12/22/2005 PRODUCER (508) 852-8500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Protector Group Ins. Agency, Inc. 100 Front Street, Suite 800 Worcester, MA 01608-1435 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY EXPIRATION DATE (MMIDDIYYI LIMITS INSURERS AFFORDING COVERAGE NAIC # INSURED Building Maintenance Corp dba US Roofing INSURER A: Acadia Insurance BMC Development LLC INSURER B: Granite State Insurance 58 R Pulaski Street Peabody, MA 01961 INSURER C: A INSURER D: INSURER E: 12/23/2005 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L N§m TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYYI POLICY EXPIRATION DATE (MMIDDIYYI LIMITS AUTHORIZED REPRESENTATIVE GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A XMAGF COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR CPA0085685-13 12/23/2005 12/23/2006 TO REN I hu PREMISES Ea occurence $ 300,000 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICYX PRO- LOC A AUTOMOBILE LIABILITY ANY AUTO MAA0085652-13 12/23/2005 12/23/2006 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY X OCCUR CLAIMS MADE CUA0085698-13 12123/2005 12/23/2006 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,000 $ $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC9683940 12/23/2005 12/23/2006500,00 WC STATU- X ICH- TOLIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 5OO OO E.L. DISEASE - POLICY LIMIT $ , OTHER A Installation Floater CPA0085685-13 12/23/2005 12/23/2006 Job Site Limit $50,000 A Special Form CPA0085685-13 12/23/2005 12/23/2006 Transit/Temp Ioc $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder and Oliver Gardens Condominiums are included as additional insureds as respects General Liability, if required by written contract, for work performed by named insured re: various jobs CERTIFICATE HOLDER rANr-FI I ATInN ACORD 25 (2001/08) © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL North Andover, MA 01845- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR - REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) © ACORD CORPORATION 1988 cn m x m Ic ,mww YI m y v m W C � CO) CO) CD C) Z y F; . �• . s o CL y O C.) o p CD CL � o Q CD CD o CD C CD co CD CD _. �O y O I !D rPo o 14 0 K n to y O • • o 0 c TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Tg SAGS �j Date Received: 0`T Permit 1>ate Issued: IMPORTANT: Applicant must complete all items on this LOCATION IF35 �h esh��,- s �Print at��� PROPERTY 9WNER�� ' ��n l� (2.Wd -e / Print MAP NO -V b aG PARCEL: TYPE AND USE OF BUILDING TYPE OF IMPROVEMENT New Building C Addition C Alteration Repair replacement C Demolition C Moving (relocation ZONING DISTRICT: HISTORIC DISTRICT YES IJ PROPOSED USE Residential Non- Residential ❑ One family kTwo or more family ❑ Industrial No. of units: C Assessory Bldg �7i Commercial Other I X, Others: i-1 Foundation only I DESCRIPTION OF WORK TO BE PREFORMED �� �. te r. r r'�k9 4--< a4+—A Identification Please Type or Print Clearly) OWNER: Name: (,n(,A Phone•'ii3 8x7 L9110 Address:- CONTRACTOR Name Address: < SV 6Z Supervisor's Construction License: Exp. Date: 2 - Home Improvement License: �3-7,a C -? Exp. Date: \--), 1 17 Ir4 - ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. 510.00 PER x/000.00 OF THE TOTAL ESTIJVA TED COST BASED ON $125.00 PER S.F. Total Project Cost :$ �, `��► I , C> xI0.00=FEE:$_q.1_ Check No.: rReceipt No.: E.-�� sS�C U Permit NO: Date Issued: Piv TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received: 4- �0 01( IMPORTANT: Applicant must complete all items on this LOCATION S.h5 ChJ -6 ,4- Print PROPERTY q'WNER D i rvnr1-e / Print MAP NO.:✓AD M- PARCEL: ZONING DISTRICT: HISTORIC DISTRICT YES 1=1 t yPE AND USE OF BU TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 0 Addition C Alteration 0 One family kTwo or more family No. of units: 0 Assessory Bldg 0 Industrial } Repair replacement L Demolition i0 Commercial E Moving (relocation) E, Other , Others: U Foundation only nRcrRiPTION OF WORK TO BE PREFORMED N Identification Please Type or Print Clearly) OWNER: Name: l�)(,nry1, V)gL�a',-A. Phone: 9-23 BS7 ---9U0 Address: 93-5 r-li-rir),-A S CONTRACTOR Name: Address: _,9 6� .� 7t' &4,Q --V Supervisor's 4,Q -- Supervisor's Construction License: Exp. Date: Home Improvement License: `37>0 C -7 Exp. Date: \--�i 17 lob ARCHITECT/ENGINEER Name: Phone: Address: Reg. No FEE SCHEDULE: BOLDING PERMIT. $10.00 PER SI000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$=7T� C)G _x10.00=FEE:$ L Check No.:Receipt No.: 2 - Date./ - N2 5 3 + TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING This certifies that I -T. .............................. has permission to perform ................ plumbing in the buildings of :q ................... at ................. / ....... , North Andover, Mass. Fee . ...... Lic. No.,: ................ PLUMBING INSPECTOR WHITE: Applicant CANARY. Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING 2' (Print or Type) o (ZT I4 ANS ✓(?ic , Mass. `Date 1Permit Building Location 3 S_ C1hQ Sohy �', Owners Name S ' ✓a +NJO'__Oss I t__ f M A o [K-5 Type of Occupyt New ❑ Renovation ❑ Replacement 2-' Pia Submitted: Yes ❑ No ❑ +I� I FIXTURES Installing Company Name_ D t3Ee-r Q . , _S,4W M AZA e 7 Check one: Certificate Address �� �� �`(; RC H /Ytr3n) pi ❑Corporation /r E % I4 o FA),yYl A O t LI ❑ Partnership Business Telephone 9--h'rm/Co. Name of Licensed Plumbed?, 3 r,P_ T fry • • SA �, yl,q r��c"` INSURANCE COVERAGE: I have alcusrrent jability insoura ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked Yes, please indicate the type coverage by checking the appropriate box. A it fifty insurance policy Other type of indemnity ❑ god ❑ OWNER'S INSURANCE WAIVER: 1 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: Sionature of ("Avner nr r'k- : A---, Owner ❑ Agent ❑ nereoy canny that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations Wormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts state Plum g e and apter of the ' oral Laws. Title re of Licensed Plumber City/Town Type of License: Master Q% Journeymah ❑ APPROVED OFFICE US ONL License Number � 3 3 5 • Y • HUM ■�����t����������:������NEI SEEN ONE nommommommommossom monsoon .. ■ENEENEENNINn00i101010101000100■ NONNI Installing Company Name_ D t3Ee-r Q . , _S,4W M AZA e 7 Check one: Certificate Address �� �� �`(; RC H /Ytr3n) pi ❑Corporation /r E % I4 o FA),yYl A O t LI ❑ Partnership Business Telephone 9--h'rm/Co. Name of Licensed Plumbed?, 3 r,P_ T fry • • SA �, yl,q r��c"` INSURANCE COVERAGE: I have alcusrrent jability insoura ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have checked Yes, please indicate the type coverage by checking the appropriate box. A it fifty insurance policy Other type of indemnity ❑ god ❑ OWNER'S INSURANCE WAIVER: 1 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: Sionature of ("Avner nr r'k- : A---, Owner ❑ Agent ❑ nereoy canny that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations Wormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts state Plum g e and apter of the ' oral Laws. Title re of Licensed Plumber City/Town Type of License: Master Q% Journeymah ❑ APPROVED OFFICE US ONL License Number � 3 3 5 m _Ic Q D z -4 m v z D m A� �o m O O c r O_ z O z O I" m m O m r O O O -n In A m c N m O z r Date.Z4�� TOWN OF NORTH ANDOVER PERMIT FOR WIRING /- T -C) ..... /)., / !� ...... f .................................. This certifies that ......................... ...... .. has permission to perform ......... .............. wiring I in the building of ......... .................................................................... C/I at...... .... ........................................... N du ,Oover, Mass. Fee..�O' 'I .......... Lic. Nq,,-A1;:M 7 ........... -i;�r �I�zi NSP ECTOR Check # Cv 1 16l' C.ommonwea[k o` Ma9dachwelb 2eparintenI 017ire Jervice9 BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORIN ELECTRICAL WORK All work to he performed in accordance with the MasS36LISCnS Electrical Code (MEC, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE, -ILL INP'O/ VL1710N) Date: 17 Iq -p3 City or Town of: >!!ltN ��r�>j� To the Inspector of FY'ires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with n building, permit? Yes ❑ No /(Check Appropriate Bos) Purpose of Building , � Utility Authorization No. Existing Service ;?Gfy ArArps ;?M/ //p Volts New Service Antps / Volts Number of Feeders and Ampacity Overhead 2---�—LhAdgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of 1Ieters Location and Nature of Proposed Electrical Work: f L v' Cour letion of the folloivine table may be waived by the his' ector of IVires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of I Total Transformers KVA No. of Lighting Outlets No. of Hot "Tubs Generators 'A No. of Lighting Fixtw cs Swimming Poul Above 111 Elt rnd. rnd. o. o mergency Ag mg Batte • Units No. of Receptacle Outlet No. of Oil Burners FIRE ALARMS t' . of Zones No. of Switches No. of Gas Burners No. of Detection a d Initiatin De Aces No. of Ranges No. of Air Cond. TotTons No. of Alerting evices No. of Waste Di s users Heat Pump N tuber :I'ons KW No. of Self -C tained Totals: Detection/A rtina Devices t"Yo. of Dishiva Aers ace/Area eatin S Spa g KW unicipal Local onnectioAA [I Other No. of Dry s Heatin liances g pp IC�� Security ystems: No of Devices or Equivalent No. of Wa er KW o No. of 1)atn .. Wiring. eaters Sins BallastsI Signs Xo- of Devices or Equivalent No. Hydromassage Bathtubs No. of illotors Total I -IPS// !Zi 1'e communications Wiring: No. of Devices or Equivalent OTHER: itttach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: ,,j5&j Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, « tttler the pains and penalties of petjttry, that the information on thus application is true and complete. FIRM NAME: Licensee: Signature (If applicableeenter ••esC t, •' in the license number line;) Address: OWNER'S INSURANCE WAIVER: I am aware that tife Licensee doe. required by law. By my signature below, I hereby waive this requirement Oivner/Agent Signature 'Telephone No. LIC. NO.: 4/29-9,y LIC. NO.:'-4,-,7-3ja Bus. Tel. No.. lo'26 Alt. Tel. No.: not have the liability insurance coverage normally I am the (check one) ❑ oxvncr ❑ oNviier's agent. Pj RJ1IT FEE: $ MORTM TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 �► ��.;.::*,� # North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspeapr of Buildings J; Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION pie= priat DATE: c- JOBLOCATION: Sz�-S S-A NCV4Y-, P�n�_Uy4�^ O1DLK Number Street Address MapJLot HOIVIEOWNER�i Crr�h Name Home Phone Work Phone 978 ((53Lf000 PRESENT MAILING ADDRESS The current exemption for "homeowners" was extended to include owner -occupied dwellings to 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) DEFiNfnON 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 or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeawncf assumes responsibility for compliances 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. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Rmm,W 10.2005 form Homeowners E=mptkm TIOARD OF \PPE:1I_S 638-9541 CO.NSER\'. HON 638-9530 ITE -UMI (588-9540 PLANNING 688-9535 City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to 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) DEFiNfnON 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 or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeawncf assumes responsibility for compliances 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. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Rmm,W 10.2005 form Homeowners E=mptkm TIOARD OF \PPE:1I_S 638-9541 CO.NSER\'. HON 638-9530 ITE -UMI (588-9540 PLANNING 688-9535 All Date:-�� . - - X'07,1f�lxl TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING S CHUS This certifies that,,<- ...... has permissic, n to perform X///. . ...... plumbing in the buildings .............. ......... North Andover, Mass. at Fee__';V' 9 Li c. N o. .............................. PLUMBING INSPECTOR Check 557 8 3 MASSACHUSETTS UNIFORM APPLICATION (Print or Type) / -/19,1d4-W,-Mass. Date 0 Building New ❑ Renovation ❑ n PERMIT TO DO PLUMBING' /O 7 Permit # � O Owner's Name o e Q's". C Type of Occupancy Residential ' Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg . &Pig. Co. Inc. Address 35 Pleasant Street Stoneham, Ma 02180 Business Telephone 781 -438-7776 Name of Licensed Plumber Gordon Switzer Check one: EX Corporation ❑ Partnership 11 Firm/Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ It you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 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 ❑ Signature of Owner or Owner's 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 isslred for this application will be in compliance with all . pertinent provisions of the Massachusetts Stale Plumbing de and Chapter 1A9 of the General laws. nature olticefted Tills Type of License: Master (g Journeyman ❑ City/TownS License Number. 8322 Z (n M N N O2 �. N W 0 �d J J N N Q U F- Z O Z N ` W d i++ O F- W a U. y W K 0 0 r- > U 4 W F N Y M N S � U Z !D y a W N N a Z C Q J LL rW- a W U a Q r Q W 3 x a a O x x J Y a°° ¢ F o y a x X x W Q o o U >`I X J W x° N O O J 3 SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR• aTH FLOOR Installing Company Name Heritage Htg . &Pig. Co. Inc. Address 35 Pleasant Street Stoneham, Ma 02180 Business Telephone 781 -438-7776 Name of Licensed Plumber Gordon Switzer Check one: EX Corporation ❑ Partnership 11 Firm/Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ It you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 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 ❑ Signature of Owner or Owner's 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 isslred for this application will be in compliance with all . pertinent provisions of the Massachusetts Stale Plumbing de and Chapter 1A9 of the General laws. nature olticefted Tills Type of License: Master (g Journeyman ❑ City/TownS License Number. 8322 t N 0 Z O z N W• V m W a a U. N J x H • N N W z a a c7 O 0 O Y N a� O N .. N t 0 it z W• m W a U. t J • N W z a U O W O Y N O N .. N O Z ~ Z W v O � U. F= ' LL O 2 0 za • a N a _Z x Oa J U. � O 2 a LL Z 3 O N 0 x J J_ 0 W P � p mW cc ( d m t U it a W• I W a U. t • N W U W Y , N .. N Z Z O F= ' O 2 W W • a N _Z x J Q � 2 a LL Z t it I 0 W a .. N Z O 2 W x a � a J a Z O N F - J_ � p mW cc m u. a 0 z O a W O J _ J a t