Loading...
HomeMy WebLinkAboutMiscellaneous - 9 TURTLE LANE 4/30/2018 (2)N O m �� �� r m z m b Town of North Andover D.B.A. — Zoning Compliance Form 978-688-9545 This form must be reviewed with the Inspector of Buildings. Office Hours are Monday -Friday 8-10 am, and 1-2 pm Monday -Thursday. Applicant Name �� �m `� u� �-— Name of Business:Address of Business: Zoning District Map 1bcp� Lot GI© Phone: 9 Z '- Zs F— 9 y S `i Nature of Business: k c GhY\ Do you own this property? Yes ✓ No If no, written permission is required from your landlord. Will you have clients coming to this property? Yes, Will you have any employees? Will you have any major deliveries? Yes No ✓ No Yes No Description of Business Activity (Must be Completed) PA 5 cin N -%-SL �`C -�� S�c�, (\J Signature of Applicant -- For Signage Refer to North Andover Zoning BylaNv Section 6 The proposed use is an allowe use in this zoning district. Issued By4 s Date -C-) t3 Z� NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street North .A,.n.dover Tel: 978-688-9545 . Fax: 978-688-9542 B USMESS F0l?M FOR TOWN CLERK DATE. NAME: c-..0 d u r 74 � ADDRESS; i �t�r� •Q ZON NGDISTR-fOT: ^ , TYF- OF)BUSINESS., BUILDING LAYODT PROVIDED: YES NO AVAFLABLE PAR MG SPA.OES: ZONMG BY LAW USAGE: YES NO BUSINESS FORM FOR TOWN CLERK 2.40 Home Occupation (1989132) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secandaxy io the use. of the building for luring piuposes. Home occupations shall 'include, "bu't not 'limited to the following uses; personal services such as furnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing o£goods, which impacts ilio residential nature of the neighborhood: 4. For use of a dwelling in any residential district or multi -family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be. employed in the home occupation, one of whom shall be the owner of the home occupation and residing in said divelling; b. The use is carried on strictly witivn.the principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customajy with residential buildings; - d. Not more than twenty, five (25) percent of the existing gross floor area of the dwelling Init. so used, not to exceed one thousand (1000) square feet; is devoted to 'such use. hh connection with such use, there is to be kept no stock in trade, commodities or products which occupy space beyond these Jimits; e. There will be no display of goods or wares visible from the street; £ The building or premises occupied shall not be rendered objectionable or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shalt include no features of desipm not customary in buildings for residential Signature i Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �j ,. ?. .......�..- ..............:...... ? has permission to perform ............................ :: ....:........................... wiring in the building of ....... -"'�s? f:r.................................................... tw�l at.............:..,_,r:..............:.... A............................. .... ,North Andover;Mass. � Fee.!:.:;:z6............. Lic. No�`.-�' i�� .......... t...i Xizr.. . ELECTRICAL INSPECT Check 8132 P (_.ommonweaR of Mamackwetta Official UseOnly g �'7 Permit No. G 2epartment of ervicea Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfonned in accordance with the Massachusetts Electrical Code (MEC}, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYP ALL INFORMATI�ON) Date: y-' p�fj` 0 City or Town of: 7QM To the Inspector° of Noires: By this application the undersign gives notice isorp%rintention to perform the electrical work described below. Location (Street & Number) 9 J 4( HV 1--C� hto . Owner or Tenant Owner's Address ti 1) Ur - Is this permit in conjunctrl�&,5/= with it? Yes ❑ Purpose of Building_ Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of ]Meters Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o ot al Trr ansformers I{VA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimmin Pool Above ❑ n- rnd. grnd. ❑ o. o mergency tg mg Battery Units No. of Receptacle Outlets o. of Oil `Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. o Initiating Devices an evices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Dispose p Heat Pump Number ons "" ' ' ' """ """" ""' """" """""""""""' No. o Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of aterKW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP firing: eecommunicattons No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electri I ork: �� r (When required by municipal policy.) Work to Start: C� 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 coy age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) -Z t.(b-)C % ::j Y1Su rQf1 Cr I certify, under the pains and ettalties of perjury, that the information on lids application is true and complete. FIRM NAME: --T-4, v, e S M ) 04Lt G I _ LIC. NO.: Licensee: Signatures IM `g-Inf LIC. NO.:_� (If applicable, enter "e e. "in fly license number lie jP�V Y 4 O Bus. Tel. No.: � Address: �►" l S`)' Alt. Tel. No.:T79c 6� 7-� � *Per M.G.L. c. 141, s. 57-61, security work requires Department of Public Safety "S" License: Lic, No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a -ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Dater6' :..}'a r��' TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ACNU /�-41" � This certifies that.......... ' has permission to perform_./.�. ...................... plum bing__!D,.Lhe buildings of at Fee.. ..... Lie. No.....'..' Check # 6518 ?^.- .......... North Andover, Mass. PLUMBING' j1 SPECTOR MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS _ Date Building Location �L>-' fC'e— �� `e Owners Name + �J `' �� e- Permit # & I l // Amount �7_ 07)Type of Occupancy 5 ° l� u � New Renovation Replacement Plans Submitted YesNo FIXTURES (Print or type)\ Ofd(+ t Check one: Certificate Installing Company Name ! �D Corp. Address 7 C' Partner. pct usiness Telephone 7g— 7 70-77 j ® Frm/CO. Name of Licensed Plumber. �� 2L Aaf-( A � UMot-L Insurance Coverage: Indicatthe type of insu ance coverage by checking the appropriate box: Liability insurance policy ft Other type of indemnity 0 Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 I hereby certify that all of the details and information I have submitted (or best of my knowledge and that all plumbing work and installations p orn compliance with all pertinent provisions of the Massachusetts State Pl By: Signature 01 Licen Ty a of Plum .ng Li Title City/Town ricense Numoer APPROVED (oma USE ONLY Agent 11 in above Master El in areAue and accurate to the this bblication will be in Journeyman ❑ Date ... 4.-`3Q b.5 TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ........�.......................�.�....................................................... has permission to perform ....//..<......................................... wiring inntthe building of ..,.. f .................................................... at ....... f ....„� , �........... , North Andover, Mass. Fee&., ........... Lic. NAA..(Ql�.. � � ........... . ..... ............... EtEcr'RICe�.[. INS SECTOR 1... - Check # �U�U DFPARTAfVTOFPUBLICS4FEIY Permit No. BOARD 0FMEPREVElVI70NRE MTI0AN527CVfR12.00 Occupancy & Fees Checked VAPMR"ArrinV FOR PERMITTO PfWORMaECMCU WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACIiUSsTS ELECTRICAL CODE, 527 CMR,.12`00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned anolies for a vermit to perform the electrical work described below. Location (Street A Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes [ZD --N-,, " (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service IeP C) - Amps/ 2�,-Yj/,:�olts Overhead `Underground No. of Meters New Service Amps 1 _ Volts Overhead ED Underground No. of Meters Number of Feeders and Ampacity m Location and Nature of Proposed Electrical Work - No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above o and Below ound Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. ofGas Burners FIRE ALARMS No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Disposals No. of Heat Total Total Pumps Tons KW No. of Dishwashers Space Area Heating KW Detection/Sounding Devices Locala Municipal Connections a Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHE Itmeaamftf iabtityhm o=Pbkvidu*gCarVi* CDMWcrtsstt�latialKowlmt Iha%e%hTu advatidpa£ofsm0the01r= YES [—,,,,TNO a INUtANCE B� p 011&R p WakbStxt hWacfianD* RqpeAad SigtWundwSRngfiesafpajlayl `P`��/PT/�i�� RRMNAME L msae ag t F a V"d Dmitical Wade S &Ugt Final (C - 11 i ddmAIL 1R L VA OWNER'SIlVSURANCEWAIVER,Ianmmthatt rf rawdIgnat thecsuatoeo eer�ss>i legla�latastoclt>uedbyMa$ad>,seltsGalaaliaws �/ a�tl3akiiiji�rc�iCCl11�j]ai11t,811w811�1h5[�lat /!/__ (Please check one) Owner Agent Telephone No. PERMIT FEE DEPARTMENT OFPUBLICSAFM BOARD OFFIREPREVEVITONREGU ATIOAN527CNR12:00 Permit No. Occupancy & Fees Checke APPLICATION FOR PERMTTO PERFORMaEClRICAL WORK /I ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELEcrR1CAL CODE, 527 CMR 12:00 S- 1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. �.- /� Location (Street &Number) C Owner or Tenant Owner's Address `y I/ cl' /JI -7 Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. �! Existing Service . Amps � olts Overhead Underground No. of Meters ( ^� New Service Ampsvolts Overhead UndergroundNo. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pod Above Below Generators KVA groundground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local a Municipal a _ Othe No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP artialataivalait YES [EJ NO E] Iha�esubmitledva6dpa£ofsamebfleOg'ioe YES ©'ANO Ifjou YES+ rldc*fttypeafaoraageb�' g1� M � o D* WC&OStat FIRMNAME li>c,Par1,tl)eteReglx!*W E&n*dValxdE1echa Woit: S Rattdr Fnal t L LimseNa �� %/fir lei �'`�/i4iJli9 � die Lioa>selVo BtsinersTd.Na AkTeLNa OWNER'SMjRANtEWANER;tamawarethattheliaasedwng ettteitsuanoeao►eagetr�si Irtialequi tasto�aedbyIviassadamlts('ateralIaws a4dthatmysig tt= Cnt&parr*MV1cadatwahcsthstaqu =ft (Please check one) Owner Q Agent Q Telephone No. PERMIT FEE 2"1 647-ff © IE 7 7 &S� �� r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING r -s. BUILDING PERMIT NUMBER: r117 DATE ISSUED: SIGN 4 ALI C Building Commi iorie"Mrispector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Cl l� iCt%� L� • 1.2 Assessors Map and Parcel Number. —1 Q 6, e 0 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. flood Zone Information: 1.E Sewerage Disposal System: Public ❑ Private ❑ --tZone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSERP/AUTHORIZED AGENT 2.1 Owner of Record y p / l/ , I -�j / l Name (Print Address'for ro�Service Signature Telephone Location fj / O , 7 4,2 { No. 17 Date TOWN OF NORTH ANDOVER ►O- 9 41 Certificate of Occupancy $ �sswcMusEt Building/Frame Permit Fee $ y Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ �aU R Check # !8346 /Pym Building Inspector ble ❑ nber //^^ V� ple ble ❑ 2�gZ Number 30 0 late 1 SECTION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildkpennit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Descri tion of Proposed Work check • bl New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑Addition ❑ t , Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brig Description of Proposed Work: laJfo f gfrTTON 6 - WNTiMATF.fl !'ACTC AJI< �� t �A Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 460 ` (a) Building Permit Fee Multiplier 2 Electrical a �Q o (b) Estimated Total Cost of Construction 3 Plumbing G° Building Permit fee (a) x (b) / 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number .+�. �.���... •+ .. .. .....�� �.., aaava l-nava• A uL %, WIVAir IM 1P" VV XX 1\ OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ).GAJ 6` J , as Owner/Authorized Agent of subject property Hereby authorize D/1 -^J .c G to act on My behaTnall matter lat a to rk authorized by this building permit application. (QhgS— Signature of Owner D Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION - 1, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge ; and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 2ND 3 RD SPAN D2AENSIONS OF SILLS DIN ENSIONS OF POSTS 1 DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS � SIZE OF FOOTING X MATERIAL OF CHDANEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: Q, CC 5 V15fbs'f-( 00, (Location of Facility) & 2W., -j- Signature of Permit Applicant Fire Department Sign off: Dumpster Permit e'� V Date the Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): (3�I IV �c \ ('1��/�F cfl S'i mc Address: X50 /`' U& 1-6 e City/State/Zip: 14uv_�- (44.. Phone#: Are you an employer? Check the appropriate boa: 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. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 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 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 1 I . ❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other • -•., m r..........a.., _ ," con "I ,,,wbt nmsv nu out Ine 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. tContractots 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. n , Insurance Company Name: tll�(_OIS 73r't,()'E 0 A Policy # or Self -ins. Lic. #: (219w66 lw66 4- ��Sg Expiration Date: 2�_o S Job Site Address:_ 6 —racrC (- / 4j, City/State/Zip:_ -46 K9_,c1U;_>A 444ja, 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 certifx under the pa'Ps and pgQities ofperjury that the information provided above is true and correct � ...V / / Oficial use only. Do not write in this area, to be completed by city or town oJyiciai 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 employersservice of another ander any contrace workers, compsation for their et o lhire� ' Pursuant to this statute, an employee is defined as ... every Person in the 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 hasnot 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 carry workers' compensation insurance. If an LLC or LLP does have members or partners, are not required to 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 bused � need only submit one affidavit indicatier. In addition, an ng current cant that must submit multiple permit/license applications in any givenY 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. Anew 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia » / E > § Z z 0 m /m z r R \ § .\ \ > « q ■ 7 i C-) ¥2 ` ' * t C m, § ' \� �$\�:��� ■ �� 0 0 E y $ � \ / \% . >:rn ® > e m ( 7 § E \ q� z � \ � ■ \ } 0 \ » Dan Gobeil 80 Munroe Street Haverhill, MA 01830 (978) 373-3135 CUSTOMER: Bill & Grace Durfee DATE: May 31, 2005 9 Turtle Lane North Andover, MA 01845 CONTRACT PHASE I: Demo most of bathroom area; enlarge approximately two feet to accommodate new tub. The job will include the following items: - Remove approximately 4'x8' section of ceiling in living room. - Demo both sides of bath and closet/bedroom walls; remove wall between toilet and shower. - Completely demo ceiling. Support ceiling joist to accept cathedral ceiling. - Rebuild bath/bedroom wall straight to cathedral and closet to be standard ceiling height. - Move tub/toilet wall enough to accommodate new tub. Remove old shower stall. - Frame ceiling for 22"x39" remote velux skylight. - Homeowner to remove floor, toilet and sink/vanity. - Drywall using Moisture Resistant board in bathroom area and dura rock in tub/shower area, and regular drywall in remaining areas. - Mud, tape and sand all new drywalled areas. - Homeowner to supply paint and do all painting. - Supply new R.H. six panel, prehung wood door to change swing in bath. Trim remaining trim to match existing. Install vanity and medicine cabinets (supplied by homeowner). Add electrical switches and outlets to code (homeowner to supply all fixtures). Location of fixtures to be determined at completion of frame and is not priced in this quote. - Clean and remove all debris. Plumbing: Add new tub (supplied by plumber). Use existing toilet, which needs to be recentered. Install double bowl pre -manufactured sink/counter (supplied by homeowner). Add new section of heat to replace piece that is too short (supplied by plumber). Continued Page 2 of 3 Any work done above and beyond above said work will be done on a time and material basis at a rate of $50.00 per hour. Pricing: Material: $2,400.00 Labor: 5,400.00 Plumbing: 2,420.00 Electrical: 1,500.00 TOTAL: $11,500.00 Payment Schedule: 1 ' Payment Due at Signing of Contract: 2nd Payment Due Upon Completion of Frame: 3rd Payment Due Upon Completion of Job: PHASE II: $3,800.00-• ZSOd.`d&�' 3,850.00 3,850.00 Cut down wall separating sink/toilet to approximately four feet high and replace vanity, sink and shower. The job will include the following items: Dura rock tub area, cut wall down, drywall, mud, tape and sand all areas. Vanity, sink and tub/shower to be removed by homeowner. All painting to be supplied and done by homeowner. - Install new vanity and medicine cabinet (supplied by homeowner). Clean and remove debris Plumbing: - Install new tub (supplied by plumber)and sink (supplied by homeowner). - Toilet to remain in same place, using existing toilet. - No electrical work requested. Any work done above and beyond above said work will be done on a time and material basis at a rate of $50.00 per hour. Continued e- 161W715" CA m m m m m 0 h MZ y CL CL H a� o d o v co CDCL o .� r� CD CD o 03 ccl C O co) _. CD CL CD O CO) CD I 9 n O z C cn 1 0 * TO H 0 9 0 7N� ya o�i,tf Z 2 ' 0 r m M a m o m x0 , S cnc 0 c_ co gw g c—a =r-4 y o Q o S. m l LEa coo So m • Cl) y��C 0 Z � =-o „Oi C -II y T m >• d .► dO m H C y —OIC J O • y - C O . o Z S. ISCa CCL .7 w M� m m y 1 O • C a3 02 m y CLO O Q C CL C.CD c=oA C CD No 0 m i w cc*,) f o O CD ti �-7 'C O CD • 4& ?;� C :•i y �m C��a Q ca S �m 1 0 * TO H 0 9 0 7N� ya o�i,tf Z 2 ' 0 r m M a m o m x0 , S cnc 0 y w 0 C r7l b C,) g � � z 0 c