The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 92 QUAIL RUN LANE 4/30/2018it Date ....5? :.... Y....... ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............�I....... ..�GfAI � ,V!L�.... .. :....... has permission to perform ....�....... ?� ... C k �? _ ��'' �Cw ..................................... ....................... wiring in the building of .... �.>.4W �k...h. e.. .......................................... ................ . at............7......, 69ui!.I........L.✓)................... , Noqh Andover, Mass. Fee ......... 5.................Lic. No ........................................... .................................................................................... ELECTRICAL INSPECTOR Check it 2 �7 rf a dommms 1. _ Y• FC �f r f i ;�}- BOARD �,' nY!! A IP �+v Lief PREVENTION M f P i .•1 `:f !i f 'fl -f:r taa .. -;R. [i . .;I:... _ ..Ri ._% _a,Yi-. � c: e: mn w *m r 7t ri` t) 4•. i8x ` I Sri .. ••2'a f 3+'111;1:1 11. f IR-4:.�-•.�14�«t .3• .� t-P•i.v. ti t: f�.+. i"x- 2f?c t' ti :.iit _.t xi Y'.. a.fi_ tiwrserwTwmmt .5HEP Dup' In a buBftg 0 1% El ( Ash md5ftawdm d" omtud C) Mdgrdfl ft otmswn: ff wrm �Yotts OM*ad ❑ iTw4gM � 1�. aiMahm InmdPktmarprapow xkzbrwwmb 7C�F J-ft747' C.l3CE cauummu ymm ux cmm= w L3 [J UU . vv [y1iM m"mm w MUWCIPW P91W ) W=ttGS �) -1.r' r W - to bs m*wgcd is hex vilth MEC RWe1 G sed comphdm S:< Sts f ..._ f •i' f !:'e 4a 71 i':'tiffii ifl / 1::t s 14 N dt! k# i i fft) f .i'.ei. 111.1 T 1111# :s .t 2a.�{ L`-+11ld .: t4 F...t rfit7 1•.'4' .� Ei ;4-i w 3IS}Y iyy ..T...1 fe fnY 1 {i I't._'.t:E4 1• F:.. 1 is t. s6? rC tli �i �f �s �i �� e � '4v I� _'!�• �+' s * Ji � � y.Sy! � r. I'. Lft i.. 2f�' eSa%e: •+ /xf' F..Y r est /+:,. l: t/#stir`. F% 8.22 l !J 1/ jtt� f !.1 f+A t8ftfa t/f r,.t f 'i+;; rt.# :f; :: r1�l ...-. �-� alY * .id � 'i.r. .��.� i '.it f fk� ' Z � � ;� ♦ f ��► � - ftt� _..JIf 1' i. eat' �[ ': t. P a'Yi •A. �'�k"-t 41 {'-:e F f e7'4i(_+?1 .P1:+� i Y ! i 4 ! . -.is 'r- o-4. rrt, t: :,. 5,e:.. •i.Lf' 111, t,..... -a ;. .r rit. t s T.f#iif Jr, i ^'l!#Ii .�f 11 It �1'.ti ilei sA .+7L •1 - i 1.: i 1 1 •f t"�'S ;tit Pt:- 1..+ y .. !'• _ka5 ..,...� tlll� �ilv_ •)'�;° "-^u•-eftet,. stt� f e: �.s4 c s `fi Esl, r1 .t. f a6laii!:YY L':1 i.Ji' 7, t.• �•.� ti .1!151 r fiti C .. 51 P =Y3.. y �� 8'7 �a.. t� Wi - .? _ Ee.s t.Y S. f t%4f9f f". tea Rat' a `if .• ! 'i S trH:?'s' !• : :i a f•L!v` ! if f !r :i� 1"" ef:.h yFis+t ft~4TF.eii Yi: xf I � .'�L«a;,! a t F� cauummu ymm ux cmm= w L3 [J UU . vv [y1iM m"mm w MUWCIPW P91W ) W=ttGS �) -1.r' r W - to bs m*wgcd is hex vilth MEC RWe1 G sed comphdm S:< Sts f ..._ f •i' f !:'e 4a 71 i':'tiffii ifl / 1::t s 14 N dt! k# i i fft) f .i'.ei. 111.1 T 1111# :s .t 2a.�{ L`-+11ld .: t4 F...t rfit7 1•.'4' .� Ei ;4-i w 3IS}Y iyy ..T...1 fe fnY 1 {i I't._'.t:E4 1• F:.. 1 is t. s6? rC tli �i �f �s �i �� e � '4v I� _'!�• �+' s * Ji � � y.Sy! � r. I'. Lft i.. 2f�' eSa%e: •+ /xf' F..Y r est /+:,. l: t/#stir`. F% 8.22 l !J 1/ jtt� f !.1 f+A t8ftfa t/f r,.t f 'i+;; rt.# :f; :: r1�l ...-. �-� alY * .id � 'i.r. .��.� i '.it f fk� ' Z � � ;� ♦ f ��► � - ftt� _..JIf 1' i. eat' �[ ': t. P a'Yi •A. �'�k"-t 41 {'-:e F f e7'4i(_+?1 .P1:+� i Y ! i 4 ! . -.is 'r- o-4. rrt, t: :,. 5,e:.. •i.Lf' 111, t,..... -a ;. .r rit. t s T.f#iif Jr, i ^'l!#Ii .�f 11 It �1'.ti ilei sA .+7L •1 - i 1.: i 1 1 •f t"�'S ;tit Pt:- 1..+ y .. !'• _ka5 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, M4 02114-2017 www.massgov/dia NVOrkers' Compensation Insurance Affidavit: Builders/Contractors/Electrbcians/Plumbers. TO BE FILED WTTH THE PERMITTING AUTHORITY. Anul cicant Information �PlaPrint rint Leibly Name (Businesstorganizationllndividu)' RSr771CAL Address: City/StateJzip: Are you an employer? Check the appropriate box: YPhone #: 97g 66'L/- S-1 7 7 l.MI am a employer with L employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.[:] 1 am a homeowner doing all work myself. [No workers' comp, insurance required.] t 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 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.t 6.❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § t (41 and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. E] Remodeling 9. ❑ Demolition 10 Building addition 11Electrical repairs or additions 12. (] Plumbing repairs or additions 13. [] Roof repairs 14. [] Other *Any applicant that checks box I! 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 contractm 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: EEAERmro &u7Z1/4t -z/,[S, co, _ Policy # or Self -ins. Lic. #: % �7 JrJ� p� Expiration Date: (.t Job Site Address: Yoh &U -nn, Rwi PM City/State1Zip: AD Ai /000 Y%, 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 DIA for insurance coverage verification. Phone #: 0Jfldal use only. Do not write in this area, to be completed by do or town offidai; City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cky/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: AC40RDr CERTIFICATE OF LIABILITY INSURANCE DAT06/111DD/YYYY) 06/182015 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 RODUCER, AND THE CERTIFICATE HOLDER. PORTANT: 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 NOMECT CLI CONTACT CENTER A/CNNo Ext): 888-333-4949 HE FAX No): 507-446-4664 ADDRESS: CLI ENTCONTACTCENTER FEDINS.COM OVdATONNA, MN 55060 INSURERS AFFORDING COVERAGE NAIC # GENERAL LIABILITY INSURER A. FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 352-965-8 INSURER B: R J PULIAFICO ELECTRICAL PO BOX 432 INSURER C: INSURER D: NORTH READING, MA 01864 INSURER E: INSURER F: a.VVCKAVCZI CERIiFiCAIE NUMBER: 47 REVISION NUM9ER n 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 LTR TYPE OF INSURANCE DL Iy UBR POLICY NUMBER POLICY EFF MIDDIYYY POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ZX OCCUR AMAGE TO RENTED P DSES Ea ocw. $100+000 MED EXP (Any one person) A X BUSINESS OWNER'S LIABILITY N N 9155590 07/25/2015 07/25/2016 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $2,000,000 X POLICY JECT LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS N N 9155591 07/25/2015 07/25/2016 COMBINED SINGLE LIMIT E ccidenfl $1,()00,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) X X HIRED AUTOS NON -OWNED AUTOS AUTOS SEE BELOW PROPERTY DAMAGE er accidenfl X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS -MADE N N 9283816 07/25/2015 07/25/2016 AGGREGATE $1,000000 DED RETENTION A WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA N 9155592 07/25/2015 07/25/2016 WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 (Mandatory in NH► If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) AUTOMOBILE LIABILITY INCLUDES SYMBOL 4A OWNED AUTOS OTHER THAN PRIVATE PASSENGER AUTOS ONLY. CERTIFICATE HOLDER CANCELLATION 352-965-8 TOWN OF NORTH ANDOVER 0 OSGOOD ST STE 2035 BLDG 20 -,,JRTH ANDOVER, MA 01845-1057 470 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 REPRESENTATIVE ® 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Location v No. �� Date &ORT" TOWN OF NORTH ANDOVER i • OOL 9 Certificate of Occupancy $ �'7b'•••° •''<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� Check #C-2�—a 18 If, 20 Building Inspector 1.1Property Address: 12, 1.2 Assessors Map and Parcel Map Numbs Number: 6 Parcel Number Sti'e D 'nt) 1.3 Zoning Information: Zaring District Use 1.4 Property Dimensions: LA Area Frontage fl 1.6 BUILDING SETBACKS ft /7- 3L16- )6(5 /1!' Front Yard Side Yard Rear Yard RegWred Provide Recmind Provided 2.2 Owner of Record: red IProvided Name Print Address for Service: Flood 1.7 Water Supply M.G.L.C.40. t.s. Zece bnformatios: 34) Peblic ❑ Private ❑ Z°ae Ootaide Food Zone ❑ qMr` r1rnW 9 _ DDADVDTV ^1 sawncq *ini • iT m,IA t/ — 1.11 Municipal Searorge Disposal System: ❑ Oa Site Disposal System ❑ _�,.__�.._ ��...�...... v��a�aJaw111iiAV111Vs �.airaasr,l�l .,�.��.v�it: L�I•`;II!t;t; v+� �'� 2.1 Owner of Record Sti'e D 'nt) Name ( Address for Service /7- 3L16- )6(5 /1!' Signature Telephone t 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervi�°r: Not Applicable ❑ Licensed Construction Supervisor: S '95!��"`wC4s-�ZLv�:'(.'�LI u��3z License Number Address 4-ZC 5-7>S— o Expiration Date -§`iBnatute-- Telephone 3.2 Registered Home improvement Contractor Not Applicable ❑ 2-17? ompany Name Registration Number Address ' 11 I (—G - 05 "I i Z6y 71 ss Expiration Date i nature,..-! Telephone C 1 SNOWz T SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 f 25c(6) I I Workers Compensation Insurance affidavit be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi rmit. Signed affidavit Attached Yes ....... 9Y No ....... ❑ SECTIONS Descirliptionof Proposed Workcheck V a bk New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Tddition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / c�TinN 6 - F. MATED CONSTRUCTION COSTS I Item Print Name litre of caner/A ent Estimated Cost (Dollar) to be Completed by permit applicant OMCIAL USE ONLY 1. Building / 6 (a) Building Permit Fee Multiplier No 3Ku 2 Electrical DIMENSIONS OF SILLS (b) Estimated Total Cost of Construction D3/lENSIONS OF POSTS 3 Plumbing Building Permit fee (a) x (b) THICKNESS 4 Mechanical HVAC _ X 5 Fire Protection 6 Total 1+2+3+4+5) IS BUELDING CONNECTED TO NATURAL GAS LINE Check Number SECTION 7a OWNER AUTHURl%ATIUM TO BE COMPLETED WHEtr OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on ' My behalf, in all matters relative to work authorized by this building permit application. Si lure of Owner Date c n rTIA N 7h nWNRR/AUTHORMED AGENT DECLARATION =��✓ ,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 Hereby and belief / �C, f' v S< . Print Name litre of caner/A ent bate/ NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIN®ERS 1Yr2 No 3Ku SPAN DIMENSIONS OF SILLS D3/lENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING _ X MATERIAL, OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUELDING CONNECTED TO NATURAL GAS LINE m m m m m m m y d C � m CO) C7 CD n Z y d O �• r c a � y n� O c v CD CDCL O Q CD cc CD C CD Ni a. C7 tin �• O O CD v COO) O CD CD Z� o � CD 0 C CD C 0 O Z 0 CD 0 _ m 0 c CL _ tG 0 V! C CL 0 CA VJ m C?�0 =__ dySa CO.), y CL m C 0 O � CL A y R = O O1 d'fl y —1 ? fl• y o y :E m 2 Amy; m a G yC*J •m :1 =r w: y = O -=r g. O yCD : COD ;W CL CL 9*m co O y y Q _ m acj moo: � 3 -yo o Wim: o •- m ® y d S CD: �I: a-: te: y O : O = W cn f➢ n cn bC ~ H" z °� ,v�tl g V/ b Z3 w �7 oGa -x °'- ,b aCa C) z °� 'TJ JQ q, p 0 cn0 �^ rD 71 a �y W a z 0 Immi 0 g. ter, CL 0bCD HIC Registration #129774 Federal ID #04-3277886 Pella Windows & Doors of Boston "Viewed to be the Best" ENTRY SYSTEM CONTRACT Sold To: 54-C Q �n e-74 Address: 4wc'I 0%,t n Pella Windows & Door; 45 Fondi Road Haverhill, MA 01832 PH: (800) 866-9886 Service: Ext. 124 Fax: (078) 556-0394 Sales: (866) Pella06 Date: 101 Flo /os ' Phone (Home) _( ) City: Mae -A AJole e- State: MA zip:'01 ?4r Phone (Work) ��) 1440 - i��%S Job site Address (If different): Phone (Cell) ( ) E-mail: 10. �/ ❑ 12. 0, ❑ 13. ❑ 14. Ey 15. ❑ ❑ 16. LT ❑ Pella Boston Will Furnish and Install: All workman's compensation and liability insurance maintained a` Warranty mailed to customer upon completion when full payment is rec i d. D Total Project Amount $ 4 (,qq . V Financed If Yes: Amount Financed $ _ (Reference # Deposit Received $ X361 S U %T_o. -� �f 2 G�_ l3 Balance on Substantial Completion $ (Payment is payable to Inns -taller at completion of job) Additional Comments:. fkcd, 49" 1444 P,tr/>^, 4 Cie eb 0— 141-5 t OrMs -F z4 Kre- Qt V.1. Ie. i., fAe-11.# A <^riAr' 4 re:. cs mil ?L.'., f Wil) 2 Cot't.�i l WL"K d .,Cr 4,V "'V PELLA IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS. PLEASE REMOVE ALL SHADES, VERTICALS, BLINDS, CURTAINS, DRAPES OR WINDOW MOUNTED AIR CONDITIONERS, PRIORTOTHE INSTALLATION OF YOUR NEW ENTRY SYSTEM. INSTALLERS ARE NOT RESPONSIBLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE ANY REPRESENTATIONS OTHER THAN CONTAINED INTHIS AGREEMENI AND "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO OF RELIED UPON BY "OWNER". YOU ARE ENTITLED TO A COMPLETELN FILLED IN DUPLICATE OFTHIS AGREEMENT. CONDENSATION INSIDE THE HOUSE DOES NOT INDICATE A WARRANTY CONTRACT SUBJECTTO FINAL INSPECTION BY PELLA CONSTRUCTIOt PROBLEM. DEPARTMENT. This contract Is a legal document. Your Pella products will be specially made-to-order for you. UNDER NO CIRCUMSTANCES WILL REVISIONS OI CANCELLATION BE POSSIBLE BEYOND THE THIRD BUSINESS DAY AFTER THE CONTRACT HAS BEEN SIGNED AND DEPOSIT PAID. BY SIGNIN( Pella Rep. Signature: Customer Signature: White - Original Yellow - Customer Date: loft W o's Date: /G Ar /,s Pink - Store Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 °�M�• www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): P�t W 1 611 d O w s Address: L% S Fool d 1 City/State/Zip: qAVCr � It /1414 0l g32 Phone M T 7,r- 2 4CS - 72 SS_ Are you an employer? Check the- appropriate box: 1. Al 1 am a employer with 2 1- 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 t ship and have no employees These sub -contractors have working for me in any capacity workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 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 10.0Electrical repass or additions 11. EJ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #I must also 0 out the section below showing their workers' compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' carp. 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:i"e G • G l► yr C Policy # or Self -ins. Lic. #: 08'1tJ BNL S 7 y 2 Expiration Date: ZJD L Job Site Address: �V " City/State/Zip: -14"- Attach 1"-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. Ido hereby certify under the 'ns andpenah es ofperju y that the information provided above is true and correct. // I /e6 -Z6s-�zs5 Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitlUcense # 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 #: - - - V ✓!ze �om�.na�zueald o�./�iaaaac%auae� N�; . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR. Number CS 089839 Birthdate: 06/19/1972 E Expires: 06/19/2008 Tr. no: 89839 f ' Restricted: X00 q SCOTT P HOUSE 854 BROADWAY #1 HAVERHILL, MA 01832 Commissioner — _ Board of Building Regulations and Standards 1, HOME IMPROVEMENT CONTRACTOR '}} i Registration: 129774 Expiration: 11/2/2007 Type: DBA PELLA WINDOWS AND DOORS SCOTT HOUSE 45 FONDI RD. HAVERHILL, MA 01832 Administrator NUMBER 069694966 DRIVER'S LICENSE DATE OF BIRTH CLASS REST HEIGHT SEX 06-19-1972 0 6-W M EXPIRES 06-19-2006 HOUSE SCOTT P 854 BROADWAY APT #1�� HAVERHILL, MA 01832 •.j r..r nanuuw ui.Y VVY1, ' ACORD >r PRODUCER Fred C. Church, Inc. 41 Wellman Street P.O. Box 1865 Lowell, MA 01853-1865 prom: Fred L. Church, Inc. 8-2-2833 5:17pn p. 2 of 2 Wo 1 tau] � ��))�45 OIITEIrILOD/YY1 _..� .....N»t..:.., ....itl.I�kwS�HYa' I.YF'i R xT..V 08!02/06 978-468-1886 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANY INSURED A Hanover Insurance Company New England Window & Door, Inc COMPANY g Mess Bey Insurance Co dba Pella Windows & Doors, Inc 45 Fondi Road COMPANY C Hartford Insurance Company Haverhill MA 01830 COMPANY .a�suTED'BELo#�114T�i1iEBE�II��iu� T�� r€�i�✓t'a �a�l°�3 �: �Lt��lc'��t�. SF4�3�t�naa.+��t�x��el� ��ama 3r,.. THIS IS ED 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 HAVEBEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCEPOLICY EFFECTIVE POLICY POLICY NUMBERDATE IM MDMY) [MITE IMMA)DNVI I UNITS; rOMER-AL I Y ZBN8181407 AL GENERAL LIABILITY 7/01105 7b1109 GEIIERALAGGREGATE i 20000009MADE ❑X OCCURPRODL,ICTS-COMPIOPAGO • 2000000 CONTRACTOR'S PROT PER80NAL 6 ADV INJURY t1000000 B AUTOMOBILE LIABILITY X ANY AUTO • 50O ALL OWN® AUTOS X SCHEDLXED AUTOS X HIRED AUTOS X NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO A EXCE88tIA&CITY X UMBRELLA FORM OTHER THAN UMBRELLA FORM C WORKERS COMPENSATION AND EMPLOYERS' UABLrTY THEPROPRIErORI INCL PARTNERSIEXECUTIVE OFFICERS ARE; EXCL OTHER ADN8162189 UHN8167306 OBWBNL6742 DESCRIPTION OF OPERA noMSRACATIONSIVBIICLESISPECIAL ITEMS Town of Needham is named Additional Insured as their Interests may appear. 10 days notice of cancellation for non-payment of Dremium. 7/01105 1 7/01 Me 7101105 7101 /08 7101106 7/01 /0e EACH OCCURRENCE • 100= FIRE DAMAGE (AnY finl • 50O -or* MED EXP Wp ant Penin, I 1D000 COMBINED SINGLE OMIT • 100= BODILY INJURY Per per"* • BODILY INJURY far Wddwnl • PROPERTY DAMAGE • AUTO ONLY • EA ACCIDENT i OTHER THAN AUTO ONLY: EACH ACCIDENT I AGGREGATE $ EACH OCCURRENCE f 9000000 AGGREGATE • 9000000 • X WC STATIJ GTN• TORY UMITS ER EL EACH ACCIDENT • 600000 EL DISEASE - POLICY UNIT • 600000 EL DISEASE -EA EMPLOYEE t 50=10 SHOULD ANY OF THE ABOVE DESCRIBED POME.8 BE CANCELLED BEFORE THE 8"ATHHr OATE THEREOF. THE Issuma COMPANY WILL ENDEAVOR TD MAL 30 DAYS ""YEN NOTICE TO THE COMFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAL SUCH NOTICE $HALL IMPOSE NO OBLIGATION OR LIABILITY OF jANY KOM UPON THE = pANYn me 1AGENT$ OR REPRESENTATIVES. AUG -02-2005 05:38PM FAX:508 454 1865 ID:PELLA PAGE:002 R=92% N Locations No. Date NORTH TOWN OF NORTH ANDOVER _ L .. 9 Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ s,kMUS 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # M -& r 17097 Alt, Inspect-4r/ Ll TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: �? J SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided RegWred Provided 1.7 Water Supply M.GL.C.4U. 54)1.5. Flood Zone Information: 1_9 Sewerage Disposal System Public ❑ Private 0 `. Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY-OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Ian Name (Print) Address for Service: y7o Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. 11 Not Applicable ❑ Lice Construction Supervisor. S 4 f�✓�- p >` � , j.��r�f ^�� License Number Address aG 6 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name ! Z—? 7 2 Registration Number Ad&ess Pb - Expiratioti Date r naturl Telephone — -- - - - - _— — 00 M X nnme z 0 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 Wilding pernfit. -Signed affidavit Attached Yes ......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: ,:?:,6 ked gceue,t4- / r CJ (r. d o,,r S /1/ �i�2v� 7`v✓Z q L ¢�!.9 yL of SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant ; ©F)FICIAI;;;>CTS;CiNi.Y ' ti .' 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) io Fa, 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 'L 00 , "'' Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Y , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application- pplication-Si ature of Owner Date Signature SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1 ST 2 3 RD SPAN DMIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 b 0 z Q 1 M W cz a 1^- y ALI LL H IC W CO3 N C O m O O O -V ` y O ; O :caa n o Z is 0 CL Q. ® d~ o a to Or~ App= O O r c .r •yy '' w O c .E n cm v m CM .0 CL; 12 E a y Z 4- C40) y .O CO C O cm O 12 Of c m 0 co C �C N m Z O Z 0 I-- 0 F. O E C L v Z O a O h p C CO CM I � C O•- � p� .— O .co)FE m m CL �� O.G }- 3 IN O CMQ. co v �cc � ■C z CD CL C, W O C s C •— C CL co � o r° v u a cn H U A � b °�° U x E W a a�' w a W W �5 U) ii x Z w z a 14 cn o co a 1^- y ALI LL H IC W CO3 N C O m O O O -V ` y O ; O :caa n o Z is 0 CL Q. ® d~ o a to Or~ App= O O r c .r •yy '' w O c .E n cm v m CM .0 CL; 12 E a y Z 4- C40) y .O CO C O cm O 12 Of c m 0 co C �C N m Z O Z 0 I-- 0 F. O E C L v Z O a O h p C CO CM I � C O•- � p� .— O .co)FE m m CL �� O.G }- 3 IN O CMQ. co v �cc � ■C z CD CL C, W O C s C •— C CL co :o �4W O C •aa mm Cc :m3 C40) L m O W a 1^- y ALI LL H IC W CO3 N C O m O O O -V ` y O ; O :caa n o Z is 0 CL Q. ® d~ o a to Or~ App= O O r c .r •yy '' w O c .E n cm v m CM .0 CL; 12 E a y Z 4- C40) y .O CO C O cm O 12 Of c m 0 co C �C N m Z O Z 0 I-- 0 F. O E C L v Z O a O h p C CO CM I � C O•- � p� .— O .co)FE m m CL �� O.G }- 3 IN O CMQ. co v �cc � ■C z CD CL C, W O C s C •— C CL co :�._a.a::v.ta',..,a....,arr��u.�.u.s...i'u:itK�xiv:trv.vi'i�ii.s.tli9v"v'iY:1u. �,__.:c'"i-_._.;.G.-.i,«`J721"`t{u:of+.cl�u-�%e.;wL...�:.w.�..�r;-F...�.::`..�.t�'•;waji..V..�y-• HIC Registration #129774 Federal ID #04-3277886 Pella Windows• & Doc Pella Windows & Doors of Boston 45 Rmdi Road "Viewed to be the Best" Haverhill, MA 01832 PH: (800) 866-9886 Ser*ee: Ext. 124 e(8)ia06WINDOW CONTRACT s: 66Pe Sold To: �C' /��a� "AA- SETT Date: I — 3 b Address: ay /1- IQy OV Phone (Home) -6 7h 6 cP; 9 o Y City: 4)0V ril� State: _ Zip: n 06 L11" P Phone (Work) ( � Job site Address (If different): Phone (Cell) ( ) Approx. Start Date: 3 - a Approx. Completion Date: 3 ' a 3 - O Y 18. ❑ ❑ New Window Units to have Slimshades -�- ❑ Cordless Raise & Lower Slimshade White Wa on DH) ❑ Tilt Only Low E (Gold) ❑ Raise & Lower Slimshade Low E (Gold) (n/a on DH) ❑ Tilt Only White # of Units Location of Units 19. ❑ ❑ New Window Units to have Cordless Pleated Fabric Shades 49 ❑ Lily ❑ Taffy ❑ Bone ❑ Celadon ❑ Mocha ❑ Golden Oak / # of Units Location of Units fi 20. tLd' ❑ Interior of 11yk*z1b be Unnfinn''�hed (Ready to Paint or Stain) (� o. v 9ylainted I �/( L9'Fella White or M<inen White )� ❑ 7 ❑ Stained ❑ Natural ❑ Provincial ❑ Cherry ❑ Early American ❑ Clear Polyurethane ❑ Golden Pecan ❑ Golden Oak 21. ❑ Roof on Bay/Bow to.be: ❑ None (Within 18" of Soffit) ❑ Asphalt ❑ Cedar 22. ❑ Clean up and vacuum rightly and remove all debris at completion of job site 23.I� ❑ Remove and Dispose of existing Windows and/or Storm Doors 24. �/❑ All workman's compensation and iability insurance maintained 25. ®/ ❑ Warranty mailed to customer uff completio hegfu ayment is received 26. ❑ —❑ / Total Project Amount $ Fi 27. ❑ t�Y Financed If Yes: Amount Financed $ (Reference # ) 28. ❑ ❑ Deposit Received $ /11— r�G G 29. ❑ ❑ Balance on Substantial Com letion $ (Payment is yable to installer at completion of job) 30. ❑ ❑ Additional Comments: �. V0, PELLA IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS. PLEASE REMOVE ALL SHADES, VERTICALS, BLINDS, CURTAINS, DRAPES OR WINDOW MOUNTED AIR CONDITIONERS, PRIORTOTHE INSTALLATION OFYOUR NEW WINDOWS. INSTALLERS ARE NOT RESPONSIBLE FORTHE REMOVAL OR INSTALLATION OFTHESE TYPES OF ITEMS. CONDENSATION INSIDETHE HOUSE DOES NOT INDICATE A WARRANTY PROBLEM. SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAK ANY REPRESENTATIONS OTHER THAN CONTAINED NTHIS AGREEMEb AND "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO 0 RELIED UPON BY "OWNER". YOU ARE ENTITLED 70 A COMPLETE1 FILLED IN DUPLICATE OF THIS AGREEMENT. CONTRACT SUBJECTTO FINAL INSPECTION BY PELLACONSTRUCTIO DEPARTMENT. TERMS AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE. This contract is a legal document. Your Pella products will be specially made-to-order for you. UNDER NO CIRCUMSTANCES WILL REVISIONS 0 CANCELLATION BE POSSIBLE BEYOND THE THIRD BUSINESS DAY AFTER THE CONTRACT HAS BEEN SIGNED AND DEPOSIT PAID BY SIGNIN BELOW.YEAR ARE ACKNOWLEDGING THAT THE ABOVE SPECIFICATIONS FOR THE PELLA PRODUCTS YOU ARE ORDERING ARE CORRECT Pella Rep. Signature: Customer .5r re rre: Date: / — 3/ —d �` Date: / _ 3 / '0/c/ White - Original Yellow - Customer Pink - Store � ✓�e %ana�nuiuueu�l� u` � 6Gtra:acivareCYS BOARD OF BUILDING REGULATIONS CONSTRUCTION SUPERVISOR ..License: Number: CS 081843 s Birthdate: 02106/1966 Expires: 02/0612006 Tr. no: 81843 6Restricted: 00 STEPHEN T DICKINSON 17 BURNSIDE LANE MERRIMAC, MA 01860 Administrator > _ X 3 _ _mCE, _ r N n n_ J. • - - The Commonwealth of 111assac1lusetts Department of III rlttstrial.-iccitlents Office of/nyestigalions 600 tV(Islrin,ton Street, /wit Floor BOs10/1, .hiss. 02111 ' Workers' Compensation Insurance Affidavit: BuildingiPluntbin;iElectrical Contractors Applicant information: Please PRINT lecribly :tame: :1V M %Ml'k site iocation tfuil address): ❑ I an, a homeowner perrorming all work myself. Project Type ❑ I am a sole proprietor and have no one working in any capacity. �J 1 am an employer proviiniz - workers' compensation for m� n'Pe contnavname: 11idq W'14ows 64 city: �44\j er 1, X14 0732, trance co. �/t1' 1ZT iCi _O ( fliS , Co . L New Cunstra,,tion ❑Rcmod�l ❑ Buddin_-, : dditioll employees working on this * , #. /-8�� B(AJ._DEtZ a3ygd l 1 am a sole proprietor, general contractor, or homeowner (circle otter and have hired a "r,tr,:ctors listed below who ii a� the roilowing � orkers' compensation polices: comnanv name: address: city: hone �: insurance co. olicv comnanv name: address: city: hone #: insurance co. Attach additional sheet if necessary Oliev # ,Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.Oo a day against me. I understand that a copy of this statement may he forwarded to the Office of Investigations of the DIA for coverage verification. I do herebp certi(p wider the Signature Print name VI - ins acrd penalties of perjury that the information provided above is true and correc-t. Date 1 �h tCLCt�tiSan �+ - -- -ruune Soo -Fs�6 - 100 ------ _ r official use only do not write in this area to be completed by cih or town official city or town: permit/license ❑Building Department ❑ check if immediate response is required ❑Licensing Board ❑Selectmen's Office contact person: []Health Department phone #: ❑Other UESTIFICA T E OF LIABILITY INSURANCE DAT'crMM/pD/YYYY; kRODUCER 07/10/03 Stai•kweather SileRiey THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 549 HOLDER. THIS CERTIFICATE DOES NOT AMEND. E) TEND OR Providence, ALTER 02901-o549 TME COVERAGE AFFORDED BY THE POLICIES BELOW. 4014-35-3600 INSURED INSURERS AFFORDING COVERAGE NAIC # New England Window And Door Inc Dba DBA Pella Windows 45 Fondi Road Haverhill, MA 01832 COVERAGES THE Fri I;JFC f1C Ir,ia Ionnirci :�rrn �-- ... INSURER A: Hanford Insurance Co INSURER B INSURER C INSURER. D INSURER R -%-NY REQUIREMENT, TERM OR CCNDrT cu QF ANYcCCfVTRACT � OTHER 10 : SURED NAMED ABOVE FOR THE POLICY PEFUOD INDICATED. NOTWTTHSTANDING ',AAY PERTAIN, THE INSURANCEAFFOFt7i ED BY THE QNTRAS TORO OTHER H��TVM RESPECTTO Y'1HICH THIS CEFMFICATE MAYBE ISSUED OR DOUCIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW. SUBJECTS:ay IS TO ALL THE TERMS. EXCLUSION'S AND CONDITIONS CF SUCH LTR INSRD) TYPE OFINSURANIC E POLICY NUMBER POLICYIEFFECTIVE POLCYEXPRATiONI A GENERALLABILITY DATE MM/OD DATE MM/DD LIMITS BINDER145262 07/01/03 07/01/04 X COMMEFCIALGENE-,AL LIAR Ui i CLAIMS MADE OCCUR uflj AGGREGA `ELIMITAPPL!ESPi POLICYF7 P=Or LOOT A AUT OMOBILEL.ABiLITY BIfVDER145261 X' I AVYAUTO ALL0WNEDAUTOS S ::-ED;,LD AU OS %� X t VON-0'XN ED AUTOS GARAGE LAB L.TY IAVYAU70 A j xCESS/UMBRELLAL.ABIL:TY SINDER143832 X I CC:,;;F CLAIMS MADE DED;:C::2LE X I �c-E''T;ON so A WORKERS COMPENSAT ON AND BINDER234-981 EMPLOYERS' LABILITY A.VY pDOpci_ CR/DA R'NFD/Ey EC;; Ti4E OFF CER/M=.OBER=(CLUDEDI t vea, oeacnoe unde- SF= :AL'�0'I,S':ONS7el" . I OTHER 07/01/03 07/01/03 07/01/03 07/01/04 07/01/04 EACHOCCUFRENCE $1,000,000 I OA MAGE TORENTEp D=G41 CCI C 51QO CQ I MED EXP(Aiyone oereon) lss.om FF=SONAL&AOVIN,.URY 51040,000 GENE?ALAGGREGATE ($10.000,000 P=ODUCTS - COMP/OPAGGI S10,00fl.000 I COMBINEDSING-c" LIMI- �.:�e�r, I $1,0oo,om °ODILY'NJURY Deroereont $ EO DILY! NJ..RY I$ 'OerO. C:denlj DDC?=DTY DAMAGE $ I A„'00VLY- FA ACCIDENTI S I 0 � R=' -IAN EA ACO I S AU -O ONLY. AGG S HAC-O=�;F=ENCE IS9000000 AGGRcaATE S9.000.000 S $ IS 071/011/04 XNC --ATL. OTH I.qV ,.(TCI G= _. cAC'i ACCIDENT D'SEASE - EA EMPLOY = DISEASE - DOLICYLIMI DES CR!PT!ON OF OPE9ATIONS / LOCATIONS ( VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT r SPECIAL PROVISIONS TIFICA SHOULD ANYOFTHEABOVEDESCR BB ED POLICIES BECANCELLED EFORETHEEXPIRA EVIDENCE OF INSURANCE DATETHEREOF, THE SSUING INSURER WILL ENDEAVOR TO MA Ilan DAYS WRITTEN NOT CE TO THE CERTIFICATEHOLD ER NAMED TO THE LEFT, BUT FAILURE TO DO SOSHAL IMPOSENO08LIGATION OR LIABILITYOF ANY RIND UPON THEINSURER. ITS AGENTS OR REPRESENTATIVES - EPRESENTATIVES. AUTHORIZ EO REP; ES ENTATIV E HCCRD 25 (2001103) 1 of 2 #83205 MBB 0 ACORD CORPORATION 1988 FAX:STARKWEATHER SHEPL ID:PELLA PAGE: 002 R=96% .r k DEBRIS AFFIDAVIT JCBSi T E LOCATION: ,vith :he provisions of c MG' 40. � s 54, a condition of Building is that debris resultingfrom as de -Fined this -,vork Si%aicispd waste disposal faose'.''. Of in a properl "C- 1 y iicensea SOLI '1 1. Z 150A. --e-C.-is "Viii Ue disposed of in: Location OT Facility k4- ignature of Permit Applicant Date Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING , SACMUS� , ,l A) This certifies that ....: -. �, . has permission to erfbrm .. !` �.. /. !.(�` C.� .� ��, � plumbing in,the buildings of . ?.rat..( .1L: -.L_ . ............ . at. �..1..f . t ...... fl. I .-'J.... ,North Andover, Mass. r Fee .� iF'/.: c � Lic. No:<�/ ./. .............................. le/HV ( 1 I.IF- / � / f ! PLUMBING INSPECTOR Check # 63�;; MASSACHUSETTS UNIFORM"APPLICAT•IO (Print or Type) AJ,�J)� PL-, Mass. Date Building Location 1j _IU A-t-,oauLd2 FOR PERMIT TO DO PLUMBING Permit # Owner's Name A u fZ N 6 T 7' Type of Occupancy-21-1� New ❑ Renovation ❑ 1 'placement Cr Plans Submitted: Yes ❑ No ❑ B . P . r SEWERS FIXTURES qFPTTt :4 Installing Company Name_ Lj-pjc/, LIJ m f rc Check one: Certificate Address_ (vr7 PLV /LjdV7""1+ s'� ❑Corporation l�L-"T`4P JI J jP74-S'S ❑ Partnership Business Telephone>5� > ❑Finn/� --�r Name of Licensed Plumber ATL F/` C(� u/ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑— No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box A liability insurance policy ❑e---_ Other type of indemnity 13 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: Zxgnature of Ownpr nr r kum—A......+ Owner ❑ Agent ❑ trtini nerepy 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 ent owledge and that all plumbing work and installations pert ml under the permit issued for this application will be in compliance with all provisions of the Massachusetts State Plumbing d ter 142 of the General Laws. Tale Sig a densed Plumber City/Town Type of License: Master ❑ Journeyman APPROVED OFFICE USE ONLY) License Number 0-I �� N S z Y < t- > 41 tN- W N YJ y N }. o 0 z <� h j O Wtn N O Z (n < C C S y Z O 2 W A-).0 N W N �- W m F- U� < rn U. ? 2 N X. z 0.S W ¢ 3 < W — < v� Z c[ n. ¢ O CX4 W i< �' o z= < -+ N e F- F' O N N z vl Z O O U- O x U z1 z J+© I to QJ J 3 _• F- N u. Ci ( 7 j n ¢ 3 SUB—BS14T. 7 BASEMENT � 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name_ Lj-pjc/, LIJ m f rc Check one: Certificate Address_ (vr7 PLV /LjdV7""1+ s'� ❑Corporation l�L-"T`4P JI J jP74-S'S ❑ Partnership Business Telephone>5� > ❑Finn/� --�r Name of Licensed Plumber ATL F/` C(� u/ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑— No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box A liability insurance policy ❑e---_ Other type of indemnity 13 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: Zxgnature of Ownpr nr r kum—A......+ Owner ❑ Agent ❑ trtini nerepy 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 ent owledge and that all plumbing work and installations pert ml under the permit issued for this application will be in compliance with all provisions of the Massachusetts State Plumbing d ter 142 of the General Laws. Tale Sig a densed Plumber City/Town Type of License: Master ❑ Journeyman APPROVED OFFICE USE ONLY) License Number 0-I �� z 0 V W 0. N , Z' N _ N W O _O a z I � r a � W M N z CL z o- o W to o wt- lu QG R. z W i o z r a M ° a o � m LL. o ti � Q uu 9 U. Q G z CL O m r O W w a ut a 2 U ` U. Q z -j:. LL lu } U kJ X V1 „ Z O N, U W IL N J Z z r. /off • , 7 i 1 Date. C7 .fes . (J.>. . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ��ACHUS` This certifies that has permission for g4 installation in the buildings of f .7 /- /--- I ....................... atr..... , North Andover, Mass. :t Fee:? ,A?). Lic.lNo.."III . O. .......................... n / / 4Z GAS INSPECTOR Checkit (/,� 51.3 A M -1 n s m N r z M n r e v m A m 0 z A M -1 n s m N r M o z C) r m cn 2 N tmtl a F In r C1 O 2 t M 'n rq ' M -� C 'YI N Z �1 r Q d C tl O O z x M o :0 ° -n � n M L O CA fit D O O x o r a -c N it �t x a M O C) m a cn 2 N a F In r C1 O 2 t Date .%f , ....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that...��1 '7. has permission to perform ...:.. ............... plumbing in the buildings of .............'. ¢� /C_,,.�w,.� at .................................. . North Andover, Mass. Fee. .. ... Lic. No ..-%/ 1 Z .... �............. . PLUM�INSPECTOR Check # 5771 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS BuildingLocation D to c' _ /�' �'CJwners Name / �Q' ren GJ vrmit # ` Amount Type of Occupancy /�e_s , New ri Renovation Replacement 0--� Plans Submitted Yes E] No .n (Print or type) Installing Company Name Address -'J"a rt ip- -'� rsa tl Check one: Certificate 0 - comp -11 Partner. E] Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 ❑ 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 installationjs.performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuset ate Plumbing Co Cha 42 of the General BY re o icense um er Type of Plumbing License Title City/Town icense lNumoer Master ourneyman El (OFFICE USE ONLY 11 a , „ • mmmMMMMMMMMMMMMMMMMMM M f **- MMMMMMMMMMMMMMMMMMMMMMMMN (Print or type) Installing Company Name Address -'J"a rt ip- -'� rsa tl Check one: Certificate 0 - comp -11 Partner. E] Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 ❑ 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 installationjs.performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuset ate Plumbing Co Cha 42 of the General BY re o icense um er Type of Plumbing License Title City/Town icense lNumoer Master ourneyman El (OFFICE USE ONLY Date . l .... . 1� .:.f... b?. TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... ;'l ......... has permission for gas installation ............ ........... in the buildings of .... ...-....:`. ........................ . at ...% . ".. fir`."...... North Andover, Mass. Fees. `�� . Lic. No. �:.�?. ? .Y1,!>r ...... . G ' GAS INSPEGfO Check # / 4 4 uJ MASSACHUSETTS UNIFORM APPLICATON FOR PERM�MIT TO DO GAS FITTING (Type or print) Date 3 NORTH ANDOVER, MASSACHUSETTS Building Locations ,/� �- r / �t 9 lL Permit #O� Amount $ �SZ Owner's Name i., New ❑ Renovation ❑ Replacement (3/ Plans Submitted ❑ (Print or type) Check one: Certificate Installing Company ''Corp. Address Z 1 L' ❑ Partner. Business Telephone �_i _ cL� ZZ / ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Checff I have a current liability Insurance policy or it's substantial equivalent. Yes No ❑ Ifyou have checked ,M, please indicate the type coverage by checking the appropriate box. 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 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Aaent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations ormed sued for this application will be in compliance with all pertinent provisions of the Massachusetts Gas ,and C pt 42 of 1 General Laws. City/Town VED (OFFICE USE ONLY) / Signature of Licensed Plumber Or Gas Fitter Plumber 4 Z f --2-- ❑ G -Fitter License Number ter ❑ Journeyman Date f.............................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING or This certifies that ................ `.......... .................................::.`................ has permission to perform ..... `f.'-.::. l ----.moi y wiring in the building of ..................................................... at../..:L................................................................... . North Andover, Mass. Fee. ... .'...... Lic. No jZ;* r.'f.. ....: l`': !- ..... 0:..' ...................... / ELECTRICAL INSPECTOR h Check # 488 �4t (gommonwalt4 of Aass*uoetto V Office Use Only Department of Public Safety Permit No. G BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 w Occupancy &Fee Checked � 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Ax City or Town of O ac -11A d U e/ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. 1 Location (Street & Number) Owner or Tenant Owner's Address C,-q� irk r to -e-- Is this permit in conjunction with ta building permit: Yes U No L_i (Check Appropriate Box) Purpose of Building �'�CV` e L) `r- :3L _Utility Authorization No, Existing Service Amps /-2-1-10 Volts Overhead ❑Undgrd New Service Amps / Volts Overhead ❑ Undgrd Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work YLI No. of Meters ❑ No. of Meters �{ 1 OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ ! have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checke YES, please indicate the type of coverage by checking the appropriate box. A B INSURANCE OND ❑ OTHER❑ (Please Specify) _ 0 (Expiration Date) Estimated Value of Electrical Work $ / %fom Work to Start /V /21 /� Inspection Date Requested: Rough ✓' (/ CA Final � r C•J Signed under the penalties of perjury: L d FIRM NAME S i A i 1-1 NSC G C C fl (-- �- LIC. NO. '` 13 y t � Licensee P11ii0'�/f JA LZ Signature LIC. NO. :3 VfP Address 1 � � � lS � S"r - 2� �c� Bus. Tel. No. 97L9--6?2- � 7�5 Alt. Tel. No. f?O �1S - 7/ f T OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement., Owner Agent (Please check one) mom, Telephone (Signature of Owner or Agent) PERMIT FEE $ w TOTAL No. of Lighting Outlets 1 No. of Hot Tubs No. of Transformers KVA Above In - No. of Lighting Fixtures SwimmingPool rnd. ❑ rnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Batte Units r No. of Switch Outlets 1 No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges No. of Air Conditioners Tons Initiating Devices No. of Sounding Devices. Heat Total Tota No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection/Sounding Devices r` No. of Dishwashers 1 Space/Area Heatin KW Municipal 1-1❑Other No. of Dryers Heating Devices KW Local Connection No. ot No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP 1 OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ ! have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checke YES, please indicate the type of coverage by checking the appropriate box. A B INSURANCE OND ❑ OTHER❑ (Please Specify) _ 0 (Expiration Date) Estimated Value of Electrical Work $ / %fom Work to Start /V /21 /� Inspection Date Requested: Rough ✓' (/ CA Final � r C•J Signed under the penalties of perjury: L d FIRM NAME S i A i 1-1 NSC G C C fl (-- �- LIC. NO. '` 13 y t � Licensee P11ii0'�/f JA LZ Signature LIC. NO. :3 VfP Address 1 � � � lS � S"r - 2� �c� Bus. Tel. No. 97L9--6?2- � 7�5 Alt. Tel. No. f?O �1S - 7/ f T OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement., Owner Agent (Please check one) mom, Telephone (Signature of Owner or Agent) PERMIT FEE $ w 11.029 - This certifies that ... Date ... el? .— . 'q z-, ...................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING has perniission to perform ... . .................................... wiring in the building of ...... ................................................ at ... ?.Eec . .o..- ............................ . North Andover, Mass. e e ....... Lic. ............ . ....................... �EbECT RICAL INSPECTOR Check # 7,7�5 619 VO4v-e4 S400 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only Permit No. Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work Location (Street & Number. Owner or Tenant Owner's Address Q jc - Date To the Inspector of Wires: Is this permit in conjunction with as building permit Yes [ No ❑ (Check Appropriate Box) J Purpose of Building F r -;F— Utility Authorization No. Existing Service Amps Vcits New Service Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical Overhead ❑ Overhead ❑ Undgmd ❑ Undgmd ❑ No. of Meters No. of Meters OTHER: W ✓L9 2 F �i�'\ i U'� N✓\ S T-t.h INSURANCE COVERAGE. Pursuant tbMe requiremenets of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = r lid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE /BOND = OTHER = Please specify) Lf .L t 6'J (Expiration Date) Estimated Value of Electrical Works Wolk to Start Inspection Date Resquested Rough Final Signed under Penal kies of perjury: �,Y „ts �% /,�I %1 LIC. NO. � & 2�P t FIRM NAME } ^C -,,t \ t_ �4 �Zll U� Q LOn t, y i ! I NO. (L 7- it l Tel No. Address l 0 Id 6S T � S� � PA U A rJ 1 � 03U(,oq Aft Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ �V (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers INA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Emergency Lighting No. of Recti tacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di sal No. Pump Tons KW No. of Sounding Devices No./ of Self Contained No. of Dis'. washers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of Water Heaters KW No. of Signs No. of Bailases Low Voltage Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: W ✓L9 2 F �i�'\ i U'� N✓\ S T-t.h INSURANCE COVERAGE. Pursuant tbMe requiremenets of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = r lid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE /BOND = OTHER = Please specify) Lf .L t 6'J (Expiration Date) Estimated Value of Electrical Works Wolk to Start Inspection Date Resquested Rough Final Signed under Penal kies of perjury: �,Y „ts �% /,�I %1 LIC. NO. � & 2�P t FIRM NAME } ^C -,,t \ t_ �4 �Zll U� Q LOn t, y i ! I NO. (L 7- it l Tel No. Address l 0 Id 6S T � S� � PA U A rJ 1 � 03U(,oq Aft Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ �V (Signature of Owner or Agent) x.116 Date... ........:........v....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING A r This certifies that ......................................................---'' has permission to perform.. .. 'i `i-- , .......................................................... wiring in the building of .... �7: �� -� { at � l -� -�- .� �-� -� ... , North Andover, Mass. Fee.�.�....�..... Lic.No.............".....�........ t...(.-'r:P •�................ /1 s • ��^�ELECTRICAL INSPECTOR Check #— TBE COAMOAWEALTHOFMASSACHUSEM Office Use only V I DEPAR7tYIMT0FPUBUCS4FEIY B0ARD0FF&EPREVEIVH0NREGUTA770NS527CttIR1 2 (X) Permit No. Occupancy & Fees Checked .� APPLICATTONFOR PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date eo- Town of North Andover The undersigned applies for a permit to perform the electrical Location (Street & Number) UQ f Owner or Tenant Owner's Address Is this permit in conjunction with jjajj��building permit: I Yes Purpose of Building b�G[ f it M ry tvlc ) Existing Service`�U Amps1.� / � Yf(Xolts New Service Amps / Volts Number of Feeders and Ampacity NrIAJ r10 >f(V Location and Nature of Proposed Electrical Work ,rI , below. do (Check Appropri to Box) 09 PUV2 AIA",/ 644tility Overhead Overhead M C f rGvt`f No. of Lighting Outlets No. of Hot Tubs No. of Lighting Fixtures Swimming Pool Above No. of Receptacle Outlets No. of Oil Burners round No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total No. of Disposals No. of Heat Total Tons No. of Dishwashers Pum s Space Area Heating Tons No. of Dryers Heating Devices No. of Water Heaters KW No. of No. of No. Hydro Massage Tubs Signs No. of Motors Bailasis Total HP Below Underground Underground No. of Transformers Generators To the Inspector of Wires: Authori zation No No. of Meters No. of Meters Total KVA KVA ivu. or emergency Lighting Battery Units FIRE ALARMS Total No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices L ---J Connections No. of zones -------- El � Other biAuarlceCovetage. Pan= tothetagt>IIernaZofMassadxiseusGer>�alL3ws [haveaaunwLiab>7ityhmmtoePbficy>r>c)udongConpice Co�.�«.itssul�mal � [ha�sUblrrdtedvalidproofofsametothe0l� YES � NO ��gdie box 1i}a►hawcirrl�dYFS,plea�itxdicated�etypeofmvgagebY NSURAN � BOND r7 OTIIER � (paseSpeffyEViralion Dale ) votictoSdtt 0�[7l � � EVahteofF7ectticalWolic$ >p0 gnedlmder'�iePaof 'Elty: RMjestDd Rao 10%- � U�. Fi(112,1 nal IRMNAME C i��see I/ I G?lIJZ (a signahue License -No � 1�4 'WGj /V � Q30�, d BusnlessTelNo. �i, fiP 7,5"_e—&k4,7 dam_ � 160-3W- 3Y.9 � WNQZ S WSURANCE W At Tel No. ANER; lam aware that the License does not have the instuance coverage 0rA3 atbstarttial alttivalertt as tegttnecl by Ma�cht�etls G,�teral Laws �lthatmysguahueonthispai7utappficahthistegttit�rterg. 'lease check one) Owner Agent M / Telephone No. —PERMIT FEE - Signature o caner or gen V Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ............... ............. has permission to perform !r� ...................... plumbing in the buildings of ................. at .... :...... -z ... tr ! ......... North Andover, Mass. Fee.A ....Lic. No........................ ' `'-PLUMING INSPECTOR Check # 5337 S x MASSA.C; ,USi;1 S J�;i;;G ,;vi A.? •�::cA; ;ON FOR PER" i j c DO PLUMBING (Print orType) Gate 6 Iq 0Z - 002 Pei -mit'- UJ -33 /7 yyBuilding Loc.ticn_____.Cwner's NameS)jEp.--,BucnF,TTC Type of New [; Rencvat;onr Re,.lacament C P ar,s Subm'ted: Yes Ci No Cl URES Installing Company Name X n is D u a effte Check one: Certificate Address_ q COG, (KAV, 1-11 l{ 1?(1. N. G Corpen, tion _ NIL arYl Nr 103W07v Cl Partnership, T �A Business Telephone i � Lp o �j'�o2q Firm; Cry. Name of Ucensed Plumber Den IS DI I (W INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142. -Yes A No O I If you have checked yes. please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity i-1 Bonn f :1 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: { Signature of Owner or Owner's Anent Owner ❑ Agent ❑ 1 hereby certify that all of the details and irforna!tSignatureo gUcensedPeu,ber in above application are true and accurate to the best of my - knowledge and that all plumbing work and instait issued for this application vrill be in compliance with all Pertinent provisions of the Massachusetts State General Laws. B TT_ Title . City/Town - Type of License: Master Journeyman l-7 APPROVED -(Z —FF iC US 0NLY) License Number � � Q 1� N i { ► �. i �. i s i t � �; yi n• -� � I >� Uf a� w � CC Ji tol awl x cn a13 a" —! - `I CIN N ul I G.I n X u yµ - IU C!41° cIT� a O�UI� r- w 131 I I©; 01it-hl� a a a oto ` sue—BS�.,T. I I{ { i BASEMENT :ST FLOOR Z N O FLOOR 3RD FLOOR 47H FLOOR 5TH FLOOR { { I { I I I f I I I { I f { ! f ( { { 6TH FLOOR 77H FLOOR { { { { { { { { STH FLOOR Installing Company Name X n is D u a effte Check one: Certificate Address_ q COG, (KAV, 1-11 l{ 1?(1. N. G Corpen, tion _ NIL arYl Nr 103W07v Cl Partnership, T �A Business Telephone i � Lp o �j'�o2q Firm; Cry. Name of Ucensed Plumber Den IS DI I (W INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142. -Yes A No O I If you have checked yes. please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity i-1 Bonn f :1 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: { Signature of Owner or Owner's Anent Owner ❑ Agent ❑ 1 hereby certify that all of the details and irforna!tSignatureo gUcensedPeu,ber in above application are true and accurate to the best of my - knowledge and that all plumbing work and instait issued for this application vrill be in compliance with all Pertinent provisions of the Massachusetts State General Laws. B TT_ Title . City/Town - Type of License: Master Journeyman l-7 APPROVED -(Z —FF iC US 0NLY) License Number � � Q Date../ /-.9.*.�/ .... ,4ORTM 1�0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ............... Das permission for gas installation ............ in the buildings of .................................... gat ?� � ./?-. A,,I, North And(ivcr, Mass. Fee: Lic. No/.�> .... _ GAS INSPECTOR Check # '/ - E.co" A±b MASSACHUSETMS UNIFORM (Type or print) k NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New ❑ Renovation Replacement ❑ FOR PERIVIlTTODO GAS ffITNG Date e 61 Permit #�� Amount $ L5 �a i r Plans Submitted ❑ Name of Licensed Plumber or Gas Fitter �� -, Z% Chec e. Certificate Installing Company ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes F-1No❑ If you have checked Yes, please nidi the type coverage by checking the appropriate box. 13Liability insurance policy Other type of indemnity 13 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ -„ -L --.._ .. _L',... a:.. _. -- ..•.-n n..A n n1e 4n t{ -u I hereby certify that all of the aetaus ano Inrormauv„ I ,Iavc buV„li„C;., kV, »YY.. » .�-• -- -- _.._ ________ _ _.. best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G oder 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) ature of Licensed Plumber Or Gas Fitter ❑ Plumber % ? 2 Gas Iter License Numbef aster ❑ Journeyman FLOOR WA KJALIALS Name of Licensed Plumber or Gas Fitter �� -, Z% Chec e. Certificate Installing Company ❑ Partner. ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes F-1No❑ If you have checked Yes, please nidi the type coverage by checking the appropriate box. 13Liability insurance policy Other type of indemnity 13 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ -„ -L --.._ .. _L',... a:.. _. -- ..•.-n n..A n n1e 4n t{ -u I hereby certify that all of the aetaus ano Inrormauv„ I ,Iavc buV„li„C;., kV, »YY.. » .�-• -- -- _.._ ________ _ _.. best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G oder 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) ature of Licensed Plumber Or Gas Fitter ❑ Plumber % ? 2 Gas Iter License Numbef aster ❑ Journeyman Date. /Z. -./-. °-/. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... --c��~`'....0 ... . has permission to perform--�->-'� ..................... plumbing inthebuildings• f . . .<.-Tr ................. at. ..t.. ��. -.. �-cT--„........... , North Andover, Mass. Fee:-). ` .. Lic. No. a.� a” . ... (" 4�11?:... C/ LUMBING INSPECTO Check # 625°7 a I MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location New 13 Renovation CATION FOR PERMIT TO DO PLUMBP Date Permit # Amount 11 Plans Submitted Yes 11 FIXTURES No El (Print or type) / Check one:_ Certificate Installing Company Name�Gl/' �?yi /qD(/ S " . IDJ Partner. Firm/Co. Name of Licensed Plumber: c--7,7, , Insurance Coverage: Indicate the—type& of insurance coverage by checking the appropriate box: Liability insurance policyff 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 I Signature Owner Agent rl 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts ��binp,hapter 142 of the General Laws. VED (OFFICE USE ONLY �of Plumbing License License 1 um er MasterEl oumn yman ❑ i 9� /;1w / / iL",(j t� Location No. a2r) Date f010-25ZK-0, �aRTh TOWN OF NORTH ANDOVER • . • OL 9 ' Certificate of Occupancy $ ncs Nu Building/Frame Permit Fee $ .� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ `� 1 Check # �laG 7743 /d/Av Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Selc>liiog for UWKW Use 0!j = BUILDING PERMIT NUMBER: r7 r7 DATE ISSUED: 10 )- s f y SIGNATURE: C/ BuilaTn—g Commissioner[InEeLctor of Buildings Date SECTION 1- SITE INFORMATION l.1 Property dress: u 00 A117 Red 1.2 Assessors Map and Parcel Number: Map Number Parcel dumber Jd [f ,t 104 410vir o r „/// y 7/ 11.33 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ ZOne Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record sly men Sur�el�t; 1� Q��l ,�� 'd N A6jover -hll. Name (Print) Address for Service —& - Sign re Telephone 2.2 Owner of Record: Tame Print Address for Service: L Sipature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: /Ledge/ Ziill"' 51o�1 Licensed Construction Supervisor: 5'? /' 1v1.� i 030-?.� Address c A4Z6o g%�- 0b�g Signature Telephone Not Applicable ❑ GS o �S�g g License Number Expiration Date 3.2 Registered Home Improvemeennt Contractor !S 1whal" y//des /12c. Not Applicable ❑ r o � g3� Company Name f �L Registration Number Z g/a60— P,�dress p Signature � Tele hone Expiration Date ou M X Z O v n SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alteratfons(s) Addition ❑ Accessory Bldg. J Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: l kerb✓ k e�lsll�r, n�s�e� iSem�f /�l,U 1a�gy�Gbr7 / j SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estima. d Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical 4.5-3)1,61 (b) Estimated Total Cost of Construction 3 Plumbing .2 4g,, go Building Permit fee (a) Y (b) 4 Mechanical (HVAC) 4 2661, qJ Fire Protection 6 Total (1+2+3+4+_5) ,Z g , 00 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN _T OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �lJl LO(d as Oxvner/Authorized Agent of subject property Hereby authorize / `JUP/ �iv/q & to act on /lt Nfy beh in1 ersrelatiwork authorized by this building permit application. Sldnatur of Nner Date SECTION 7b OWNER/AUTHORIZED AGENT /DECLARATION I, %tlit/7aU LI��h .-.as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Sianatare of Owner/A nt Date 7 NO. OF STORIES SIZE BASENIENT OR SLAB SIZE OF FLOOR TIMBERS 1 21D3 RD SPAN DIMENSIONS OF SILLS I:LIvtENSIONS OF POSTS DIMENSIONS OF GIRDERS ILFIGEIT OF FOUNDATION THICKNESS SIZE OF FOOTING X NMTERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE if The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # F -1 I am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Comoanv name: l ICJ,116U46 119(, Insurance Co.. f�f��SS 4�d�gp�C. Policy_,# y,/GA 006gdog13 Company name: Address Cita• Phone #: Failureto secure coverago as required UnderSection M:orMGL 152 can lead to the imposition of ctiminal.penalties of,2ifine up tb$1,50C and/or one years' imprisonmentas weU_as.d dl.penafties.3olhei=4-a-STOP.WDRKDRDFR.and_aline4-($IJOD:DQ)-achy-againstme I understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification. I do hereby certify underthe pains and rities fperjury that the information provided above is true and correct. Sinnature ////P}�c�,�1 Date 10/is X09 Print :hone.# 6,,23) T9f-iNKe Official use only do not write in this area to be completed by city or town official' City or Town Permit/Ucensing Building Dept ❑Check if immediate response is required 0 Licensing Board ri ' Selectman's Office Contact person: Phone #: Health Department Other i North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: n 01 / \ (Location of Facility) i-na re of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector A A A tz 0 tz: Er WD C: All A3 00 eb CrQ Pa to 06 CL lz to 9 4 I ✓/e v� anr�nw�ureal!/ a�._/�aavcu.`ucaelta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR `z Number: CS 075668 Birthdate: 04/29/1963 Expires: 04/29/2005 Tr. no: 10234 Restricted: 1 G MICHAEL D LIVINGSTON 57 HOOK RD (w.•. rr_� AUBURN, NH 03032 Administrator t i c y O d CO) CM) ca � O CD 0 a c2 O CL q Ce '):N CO � O � � O o p o.`� o Qww:,, =r = CD = o CD -• o �O y CD CO) I O 0 O CD 00 s QMcr Go- z 0-0 y ,o 3 CL m 0 � m nsINm m �omw !C« ti 0 JE �m - m S o -� Co �o 0z C- 14 oqo m a ait MO > > CC . Cc cCD c CL G d N02 3 N O C CK : a CL y �` y O m� 1 y ge,: * �` OCD cob N �/ wC2-� CD � O d -w O m : — 01 dt O� CL -S O � O .yi O C O O . OJ R M All dimensions _size designations given are 7 7, subject to verification on job site and TFrnro_ccia adjustment to fit job conditions. Basement Asbuilt.kit This is an original design and must not be Designed: 07/20/2004 released or copied unless applicable fee has Printed: 08/27/2004 been paid or job order placed. Fp 1 1 Drawing #: 1 1 Scale: 0 1/4" = V d �A CrF 310:" 103" '1 36" 171'," 85.E 1 93z" -moi- 84'• 122 :'• pgopoSeo All dimensions _size designations given are20 subject to verification on job site and adjustment to fit job conditions_ Basement Design 2.kit %z m 1,-,r II This is an original design and must not be I Designed: 08/18/2004 released or copied unless applicable fee has Printed: 09/20/2004 been paid or job order placed_ Y 1 1 Drawing #i: 1 I Scale: 0 1/4" = 1' Date. 4/— .......................... 0 '0 63' o- TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that Z.'.I .. .............. has permission to X perform ........ A Pe4.. wiring in the building of .............. ................................. at ............ 9-Z ...... O-V-'!�AA ........ . RAV. .... 41.), North Andover, Mass. Fee...' O -0- Lic. No. 1.2.Y7,?./? ....... Check # 5517 Commonwealth of Massach Department of Fire Se.ry es^ BOARD OF FIRE PREVENTION REDULA T IONS Official Use Only Permit No. S5/ Occupancy and Fee Checked [Rev. 11/991 leave blank) APPLICATION MIR PERMIT7the9astcl,-!.1sc1!sE4FORM ELECTRICAL WORK All work to be perforri,.d in accordance with Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYRE ALL INF TION) Date:- City or Town of: may•_ A ND QV�� Z', the Inspector of Wires: By this application the undersigne(-! g.;; es notice of his her intention to peri,)r-n the electrical work described below. Location (Street &Number) ��_Q (�A f I �RIJ A) �_0 A 1i Map: Lot: Owner or Tenant 'RUR1Ue tT Telephone No. Owner's Address S IPJA4 L° Is this permit in conjunction with a b*iilup'r� V., min: Yes W No ❑ Building Permit# Purpose of .Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts -,vencc-ad ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed :� lectrical Work: S Lo IN '1'" l� G (� 'omelet �. Ii o the r"ollowin table may be waived by the lns ector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fan3 No. of Hot Tubs No. of Total Transformers KVA _ No. of Lighting Outlets Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ ln- ❑ rnd. rud. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches1f y oas GBurners No. of Detection and Initiating Devices _'4o. No. of Ranges No. (;f A;; Cond. Total Tons No. of Alerting Devices _ No. of Waste Disposers Hea"'S;.^.3 5 Number Tons ........................ KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliannes KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Bx;lasts Data Wiring; No. of Devices or Equi alent No. Hydromassage Bathtubs _ No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER:1 O GAte ��1 Y b •.ceitional detail if desired, or as required by the Inspector of Wires. INSURANCE' COVERAGE: Unless waived by the owner, no n:r,i,it for "Ile 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 cover,ge is in force, and has exhibited p: ,of of same to the permit issuing office. CHECK ONE: INSURANCE !;OND [I OTHER [I(Specify:; - (V (Expiration Date) Estimated Value of Electrical Work: 3 foo (When required b). n-,i_cnicipal policy.) Work to Start: 12.h loy h.5pe:, ins to be requested in acc=;: _ mce with MEC Rule 10, and upon completion. certify, under the pains and penalth.,v c, perjury, that the it.fiormat,on on this application is true and complete. FIRM NAME: k 1306 ELe CT �1 C4L --X f- 9. LIC. NO.: lqq7ZA Licensee: iisp �=gw5/47-7,1_ Si:;nature LIC. NO.: 31w"o e (lfapplicable, enter "exempt" in the license ,ul-..er tine.) Bus. Tel. No.19 + ft -5) 4j Address: 11Pj 4tx St - V qp- - Ole, -The --j Alt. Tel. No.4gU!t1S"-1/ S5 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 '1'elephon�� No. Date... ' �.. �:�..... I I ,ORTk TOWN OF NORTH ANDOVER O � D • PERMIT FOR GAS INSTALLATION . y h SACHUSESS , This certifies that ... ..... .... '` :lG................ . t has permission for gas installation ..... in the buildings of .': Z.. .:: 1..� ......................... . at ...... ...:•: !:.: :... 4: ry ....... North Andover, Mass. Fee �..r'�. Lic. / No.//..,;.. ... a1— ^.!h�� ......... GAS INSPECYOR Check # 3;3 19 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING tralt or Type) A) rv- 4pudo 0 c4ass. Date Permit * Building Location �, (,(l) CRt I �U Owner's Name -- U ENLtt Type of Occupancy KCQ New 1/ Reriovation ❑ �Replacement.❑101 Plans Submitted: Yes[] No ❑ Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET ® Corporation 103C MIDDLETON , MA 01949 ❑ Partnership Business Telephone 978-774-2760 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter WILLIAM R. HARRIS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes X3 No ❑ It you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy HM 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: Ownero Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted for entered) In above application are true and accurate11ye the best of my knowledge and that all plumbing work and Installations performed under the permit for tfds wll In lance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the rat taws. By T of License: Plumber Signature o um r or as �t er Title Gasfitter 3785 aster License Number City/Town Journeyman c w Y Y a' V _ ■rrrrrrrrrrrrr■ rrrrrrrrr■ ■rrrrrrrrrrrrrrrrrrrr�rrrr� ... ■rrrrtrrrtrrrrrrrrrrrrr�rrrri ' ... ■rrrrrrrrrrrrrrnrrrrrrrrri m' ' • ■rrrrrrrrrrrrtrrrrrrrrrrrr■ ... ■rrrrrrrrrrrrrrrrrrrrrrrrrrr� - ... ■rrrrrrrrrrrrtrrrrtrtrrrrrrrr' .. �rrrrrrrrrrrrrrrrrrrrrrrrrr' � • • ■rrrrrrrrrrrrrrrrrrrrrrrr■ ... rrrrrrrrrrrrrrrrrrrrrrrrr■ Installing Company Name YANKEE GAS Check one: Certificate Address 140 SOUTH MAIN STREET ® Corporation 103C MIDDLETON , MA 01949 ❑ Partnership Business Telephone 978-774-2760 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter WILLIAM R. HARRIS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes X3 No ❑ It you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy HM 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: Ownero Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted for entered) In above application are true and accurate11ye the best of my knowledge and that all plumbing work and Installations performed under the permit for tfds wll In lance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the rat taws. By T of License: Plumber Signature o um r or as �t er Title Gasfitter 3785 aster License Number City/Town Journeyman c Y 2 U j_ Date. % - `'~ �/. NORTH TOWN OF NORTH ANDOVER py`s,,a° p PERMIT FOR GAS INSTALLATION This certifies that ... 9 .... has permission for gas installation `:, .................... . !;p the buildings of .. .r: :1. �:._ ::.. �.................... at . :.. r - ,..: ......... ....... North` Andover, Mass. Fee. j'? ...... Lic. No./—. �... - `,......... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING r �� (Print or Type) .Zv P ra, N Mass. Date 19 Permit # 32— �- 2— Building Building Location Ao( ?,VW Owner's Name Ick vRNc'°f I Type of ccurancy (��st _� nuc New ❑ Renovation Ca! Replacement ❑ Plans Submitted: Yes U No ❑ FIXTURES Installing Company Name i. �, ('� t�NK Address 308 MAW STREET RROVELAND, MA 01834 Business Telephone Name of I icensed Plumber or Gas Fitter As-,-�` Check one: Certificate Cl -Corporation 132 C ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current li bility insuranee policy or its •iiktantial equiralcvtt which nivek the requirements of MGL Ch. 142. Yc".INoll It you have checked yes, please indicate the tyle- coverage by checking the appropriate box. A liability insurance policy I,{/ Other type cif indemnity I I Bond I 1 OWNER'S INSURANCE WAIVER: I am aware teal the licensee does not have the insurance coverage required by Chapter 142 of the Mass. Genefal I aws, and that my signature on this permit application walves this requirement. Signarllre of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ 11% 1 hvwhp r rrtiw Thal all of the detail, and info,mation I have submilwd for enleied) in the above application are true and accurate to the Lest of my knowledge and Ilial all plumbing work and inctalLaion, performed under the permit issued for this application will be in compliance with all iii-ninent provisi:;; has Code and Chapter 142 of [tie General Laws. Type of License: Ry f I Pluming ---Tide Plumber or Cas Fittrr I I tow nrymanC:ilyflown 'V APPROVED (ORICE USE ONLY) ■■■■■■ ■■■■■ ■■■■■■■■■■■ BASEMENT Ist FLOOR ■■■■■■■■■■■ ■■■■■■■M ONO■■NNNNM■M■MM�M■■■■■M■■N■ ,•• ' ■■�■MOM■■MM■ ■■■ mom ■■MONO FLOOR EMMOM MMOM 5th FLOOR MMON mom FLOOR4th ■■■■M■■NN■■■ ■MM■ ■MMM■MM■■ON■ ■■■O■■MOMMME Installing Company Name i. �, ('� t�NK Address 308 MAW STREET RROVELAND, MA 01834 Business Telephone Name of I icensed Plumber or Gas Fitter As-,-�` Check one: Certificate Cl -Corporation 132 C ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current li bility insuranee policy or its •iiktantial equiralcvtt which nivek the requirements of MGL Ch. 142. Yc".INoll It you have checked yes, please indicate the tyle- coverage by checking the appropriate box. A liability insurance policy I,{/ Other type cif indemnity I I Bond I 1 OWNER'S INSURANCE WAIVER: I am aware teal the licensee does not have the insurance coverage required by Chapter 142 of the Mass. Genefal I aws, and that my signature on this permit application walves this requirement. Signarllre of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ 11% 1 hvwhp r rrtiw Thal all of the detail, and info,mation I have submilwd for enleied) in the above application are true and accurate to the Lest of my knowledge and Ilial all plumbing work and inctalLaion, performed under the permit issued for this application will be in compliance with all iii-ninent provisi:;; has Code and Chapter 142 of [tie General Laws. Type of License: Ry f I Pluming ---Tide Plumber or Cas Fittrr I I tow nrymanC:ilyflown 'V APPROVED (ORICE USE ONLY) A 2 N T n x m N T T m D T T n m 0 O C z c In mm O O M Z T M. O 3 T n 0 m O v c o m • z Z n O `1 x m N N Z N A T n 0 z N 1 Location No. Date TOWN OF NORTH ANDOVER ro . Certificate Occupancy * ; , of $ s�cMuse Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ �— Other Permit Fee w00a $ a s TOTAL $ a S # CA S.4 Check ' �' / Building Inspector ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �'� '3's �` -? r t -b: -s .ix" ��L7 }�la;�{�7!.:;, �37{. V� e *x� � k��'`n "S �""�'C`•-ai^ � Sd" �k' ,.'g'�$.. h BUILDING PERMIT NUMBER: _ DATE ISSUED: CD 00 SIGNATURE: Building Commissioner/InEREtor of Buildings Date ar,%.lavi,q 1- allr, lull r %JrUVVL I lull 1.1 Property Address: N I I Iddier 1.2 Assessors Map and Parcel Number: 60 Map Number Parcel Number ,1.3 Zoning (Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area s Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record , aem & Name (P Address for Service (q,T6) 0 Signature Teleph 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone A SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: .rAII� a Amt SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant {3F71CIAL ITSE ONLY 1. Building e (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. .Signature of Owner 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 \) — 40111 rint Name sI oD Signature of O er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMERS 1 sr 2ND 3 RD SPAN DIN ENSIONS OF SILLS DIN ENSIONS OF POSTS DRvIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHINFNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE WOOD STAVE 1�ISTLLt aUN#-E I LIST ) Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New U,ed. B. TOradiant Circulating C. Manu acturer —Lab. No. Name/Model No. A/ ,. fPnllar size Dimensions/ Height I_t?ngth Width�� Chimney l+ i A. New 4v/ Existing B. Size (flue area) 6 C. Other appliances attacPed to flue (Number and I e iz D. Prefab (Manufactu_rP,r'—name and type) (d1�ff _fi d E. Masonry/Lined �1l _ _.Flueliner_ _ Unlined Type 3 manulacluror) F. Height (refer to diagrams) cap CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction C. Minimum dimensions (refer to diagram) Clearances and Wall Protection (see stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE coRriER 121t htlf{. 1Zn\ MIN. I$�l h�ilN. HEARTH WALL/CENTER ARDMOSM %Mw - - ry (p < F O i G7 Pj E :P, S O` N N IJ IJ — O: 4' l 26' 24-3116" Y . k r ?-8!I6. 16-13116' a• ryuo tr ,z a r vc ° o a o :71 ti A. a N cc rJ n.° 10, 00 O O n r 05 o 1 C c H w c m r c 0¢ H c- .� j C ;11G C. aR S j• n. J 1 7 r Q fJ C ��\ <? : � . � � \� � a � 2 \� � � \� \ \ \\\ » . \\ \\� � � � � ƒ v pfo - moss m m m m Cl) V/ 0 .... H 10 CD O O CO2 0 H CDd n O CD CD H CD CA M- p � _ �• fe O Q H FL, O S. m CO) m0 CD C')CAC2co rn Z ti• CD ,* p a ?10 vi _•I Oy, .0-► .to dam O H T iO n?n ym y a OO C om m =a CIO 1 U2 0 n O OZ col 'U• � ' 0 N COL m m y O m : 0 H '�• O pa ry• O y O. =r. Q z Wz cn o a C to CD OO r) � o �o Cn C2 � y42 CD cn cz Cn r ; = t: d€ d.Wo C q c O d ccn o w z x w 0 oGa o X c o A tri n X o r- ro M x w n� -- o o c ^ o Q D oni 0 0 c m m m m Cn Cl) 0 CO2 ,, Z CD O d d .o POO .0 0 -1 O p CD CL � cr d CD CO) CD 0 CD CA d %oc. d 0 CA O CA CD CCD CD a. F CD OO ny c a N y n CLO m 0 C7 -� CO Ato -� o N Cl) .. rL C a. = Z =r= y -4 D T CL 0� doom o_� N O 3E =O = a O N O cc -kO' N O oy:C h =r C. ►� N Q a 8 COL rr : o mss: VJ O O N cn �My m OO d N :r C V V cn a cn V C CD :p O O O . cn z CA �G FtCD c cn 3 c d C hod. F j y 0 :V MC O m CD r v Cf) cn to ., Cl '�? 7d z ql C/) 7y m C� z �? o to ? (� r� o o CLo d x 4k V 10 a 0 c q 3675 Date.&..—q .!-�. :> TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .... S.. 5. c.......Ks.t. ...... Co ................. has permission to perform .... vn.P.Aco ........... ............... gwiring in the building of ............ . ...................................... at ....... .. ..................... .North % Ando,Mass. Fee. U... Lic. No/ -.-.................ELECTRICALNSPECTOR Check # a <62 (f11nmonwea11 o f Masjac1tueelfs cc�� Official use only 2epartmenf of ire Servicee Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO All work to be performed in accordance with the Massachusetts Electrical Code (i EC), 527 CNIR 12.00 RK (PLEASE PIUNT IN INK OR TYPE ALL INI:OR,11ATION) Wte: r,2 -?- Q 2, City or Town or: ,prj/j�it 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 &C Number) q� ��J/L/�t►� Owner or Tenant Owner's Address Is this permit in conjunction with n buildbw permit? Yes C Purpose of Building Telephone No. No 9— (Check Appropriate Box) Utility Authorization No,_O 6 0 S z/5' ExtsUnb Scrvtcc UG Anips �1'olts Overhead ❑Und�rd • b LJ No. of Meters . G New Service 000 Amps Z��Vults Overhead ❑ Undord b [� No. of tlIeters Number of Feeders and Ampacity Locatiun and Nature of Proposed Electrical Work: 11 !tach additional detail if desired, oras regrtir•ed by the Inspector of 1Vires. INSUPLkNCE 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 iii force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSWLANCE M 13OND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certifj•, under the pains and penalties of perjury, that the information on this application is trite and complete. FI101 NAME: LIC. NO.; 6673A Licensee: Ed Richard Sionature C. NO.: (If applicable, enter "e.,•enrpt" in the license number line) Bus. Tel. No.:Z$L-3-9 `-7 5 R 0 Add ress: Alt. Tel. No.:7 R 1--195-77 7 5 OWNER'S INSUIZArCE WAIVER: I am aware that the iceluee does not have the liability insurance covera,e normally required by law. 13y lily signature below, 1 hereby waive this requirement. I am the (check onc) ❑ owner ❑ owner's a,ent. Owner/Agent Signature 'Telephone No. PisRHIT FEE: S L S 93 It Check # 66 `� �TBuilding Inspe ter Location No. Date �aRT� TOWN OF NORTH ANDOVER 3?O'.o ,•1.x.0 9 Certificate of Occupancy $ s�CwusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /'y oy It Check # 66 `� �TBuilding Inspe ter TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s sft*m for,ofriciatuse t3�! BUILDING PERMIT NUMBER: I L41DATE ISSUED: SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: Cja �aJ'A', e�� Z� 1.2 Assessors Map and Parcel Number: (� 0 010 Map Number Parcel Number 11.�o:ty� .Aswi�u�c�L 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.GLC.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record K,AMtVs �.- s�� c3, �,�� as cL Name (Print) Address for Service 1 aa- ti -70L4 Signature Telephone 2 " O-wner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ?a � 1L. Coo-z---nZ. Licensed Construction Supervisor: Addr -Signature Telephone Y Not Applicable ❑ es U % 7s-6 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ 106b77 Company Name ` f 140L Zt / S�` 1611 u!�y 30 ?j Registration Number Add 00, Expiration Date Signature Telephone 00 rn X Z O v rn SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) 71 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......C3-' No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ 1 Repair(s) ❑ Alterations(s) R' I Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Des�J Description of Proposed Work: i (j L ��z A� I��ty r-,,Aw.,.c-S-!e- \,C c I SECTION 6 - ESTIMATED C0NCTRITrT1nN rncTc Item Estimated Cost (Dollar) to be. Completed bpermit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) j 4 Mechanical (HVAC 5 Fire Protection 6 Total 1+2+3+4+5 1 Check Number OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf. in all matters relative to work authorized by this building permit application. Signature of Owner Date LSECTION 7b OWNER/AUTHORIZED AGENT DECLARATION t, 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 t of Owner/. 7 -J'U 3 Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS FREIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE V, M o c o � C y ' � C vV •nom CL C M eo CD o CD oCD E Q r0+ C Lo or = i=. V w0+ a y E_*%, rQ0 CD 00 m c E ti zN m y•:m3��. cm c o N ea O 93 'awe m N 0 CUD -Cc* os 0C=M c : N Q � . nc m O L) Z O w:� coo c t- o. Q :cmc •o CO) r0+ N m H 0 t LU mo �g c _H dt 0 C Z U= �E •N o L.2 m p m c co n 0:e o6 _ m =oy•O H t w nwm O R O O O CC 6 Z O cm y Ci y E co L O C O O Q CL CA 0 V .7= y O V O Plft _m CL. is L O cs CD CL y C CM C O Q mm O � O o a CL cm< ca J •O O di Z CD C. H C 0 U) w w crw CO O w v V) U w O a: ,aj,, U w w p r� G w GG w w p u: y Un G w" p p c4 C w � CO Un Un o c o � C y ' � C vV •nom CL C M eo CD o CD oCD E Q r0+ C Lo or = i=. V w0+ a y E_*%, rQ0 CD 00 m c E ti zN m y•:m3��. cm c o N ea O 93 'awe m N 0 CUD -Cc* os 0C=M c : N Q � . nc m O L) Z O w:� coo c t- o. Q :cmc •o CO) r0+ N m H 0 t LU mo �g c _H dt 0 C Z U= �E •N o L.2 m p m c co n 0:e o6 _ m =oy•O H t w nwm O R O O O CC 6 Z O cm y Ci y E co L O C O O Q CL CA 0 V .7= y O V O Plft _m CL. is L O cs CD CL y C CM C O Q mm O � O o a CL cm< ca J •O O di Z CD C. H C 0 U) w w crw CO NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: C (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ACORq CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY) PRODUCER (603)669-0704 FAX (603)669-6831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT180N 003 Infantine Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 5125 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Manchester, NH 03108 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Joyce McMann INSURERS AFFORDING COVERAGE INSURED Blackdog Builders, Inc. INSURER A: Acadia Insurance Co. 7 Red Roof Lane Unit 1 Salem, NH 03079 INSURER 8: INSURER C: INSURER D: I INSURER E: COVERAGES THE PCL:CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE WSURED NAMED ABOVE FOR THE PCUCY 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. NSR _TR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY CPA006920011 X COMMERCIAL GENERAL LIABILITY 07/01/2002 07/01/2003 i EACH OCCURRENCE s 1,000,( j _ FIRE DAMAGE (Any one Fre) S 250,( CLAIMS MADE a OCCUR A XCG2503 CG2504 MED EXP (Any one person) $ 5 I GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PERO CT X ! LOC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL PERSONAL & ADV INJURY S 1,000 GENERAL AGGREGATE S 2,000 PRODUCTS - COMP OP .4GG 5 2,000 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY AUTOMOBILE LIABILITY 1 ANY AUTO A�I ALL OWNED AUTOS ! SCHEDULED AUTOS � X i HIRED AUTOS X ! NON -OWNED AUTOS —i CAA006920311 I 07/01/2002'-07/01/2003 j I COMBINED SINGLE LIMIT (Ea accident) S 1, 000 BODILY I Per personon)) S BODILY INJURY (Per accident) S DESCRIPTION OF 0PERATIO NSiLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I I ,,. , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY ANY AUTO I I BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY For Informational Purposes AUTO ONLY - EA ACCIDENT S � OTHER THAN E.A ACC S AUTO ONLY: AGG S F EXCESS LIABILITY ICUA006920511 X OCCUR u CLAIMS'AADE A !�— DEDUCTIBLE I j RETENTION S 07/01/2002 07/01/2003 ; EACH OCCURRENCE S 11000,0 AGGREGATE S 1,000,0 I S , S S WCRKERS COMPENSATION AND IWCA006920411 EMPLOYERS' LIABILITY '4 OTHER 07/01/2002 07/01/2003; I X WC S TORY L M TS I ER L. EACH ACCIDENT S 100,0 E.L. DISEASE • EA EMPLOYEE S 100,0 E.L. DISEASE - POLICY LIMIT S 500,0 DESCRIPTION OF 0PERATIO NSiLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I I ,,. , (SIAL UKU i UKMUKA I IUIN l `Jdd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY For Informational Purposes OF ANY KIND UPON THE COMP ITS AGENTS OR REPRESENTATIVES. rAUTHORIZED REPRESENTAT5 (SIAL UKU i UKMUKA I IUIN l `Jdd BLACKDOG Kitchen & Bath Remodeling Center 7 Red Roof Lane* Salem, NH 03079 • (603) 898-0868 SALES AGREEMENT Purchaser: Karen and Shep Burnett Home Address: 92 Quail Run Road City/State/Zip: North Andover, MA 01845 Phone Number: 978-682-4704 Delivery Address: Same 1. BLACKDOG Kitchen & Bath Remodeling Center, hereafter referred to as "Seller", agrees to furnish the materials and services set forth in the drawings dated 3/19/03 and specifications annexed hereto. The Purchaser agrees to make payment therefore in accordance with the schedule of payment. Contract Price..........................................................$ 33,296.85 5% Massachusetts Sales Tax ....................................$ 1,664.84 Total Contract Price ..................................................$34,961.69 Schedule of Payment: Retainer......................................................................$ 1,500.00 Upon signing of this Agreement .............................$ 16,730.85 Upon delivery of product from manufacturer ........... $16,730.84 This agreement includes the terms and provisions set forth herein. Please read and sign where indicated. 2. The standard form of warranty shall apply to the service and equipment furnished (except where other warranties of purchased products apply). The warranty shall become effective when signed by the Seller and delivered to the Purchaser. The warranty is for three years on materials and labor. (Should the Purchaser not contract with the Seller for installation services, then the three year warranty is for materials only and any product failures due to installation errors shall not be covered under the warranty.) 3. The delivery date, when given, shall be deemed approximate and performance is subject to delays caused by strikes, fires, acts of God or other reasons not under control of the Seller, as well as the availability of the product at the time of delivery. 4. The Purchaser agrees to accept delivery of the products when the products are ready. The risk of loss, as to damage or destruction, shall be upon the Purchaser upon delivery and receipt of the product. If the Purchaser is unable to accept delivery when the products are ready, payment per the terms of this Agreement shall still be due. Storage facilities and means of redelivery will be made available to the Purchaser by the Seller; any cost associated with storage and redelivery service will be paid by the Purchaser. Blackdog Sales Agreement, Continued Page 2 5. The Purchaser understands the products described are specifically designed and custom built and that the Seller takes immediate steps upon execution of the agreement to design, order and construct those items set forth herein; therefore, this agreement is not subject to cancellation by the Purchaser for any reason. 6. No installation, plumbing electrical, flooring, decorating or other construction work is to be provided unless specifically set forth herein. In the event the Seller is to provide the installation, it is understood that the price agreed upon herein does not include possible expense entailed in coping with hidden or unknown contingencies found at the job site. In the event such contingencies arise and the seller is required to furnish labor or materials or other work not provided for or contemplated by the Seller, the additional cost with be calculated and agreed upon in writing by both the Seller and Purchaser before the work is to be performed. In the event that a cost cannot be determined before the work is to be completed, then the work will be paid for by the Purchaser at the following rates: $75.00/hour for design services, $35.00/hour for carpentry services (with the exception of specialty trades whose rates will be quoted and agreed upon in advance) and materials at Seller's cost plus 20%. Contingencies include, but are not limited to: Inability to reuse existing water vent and waste pipes; air shafts, ducts, grilles, louvers and registers; the relocation of concealed pipes, wiring or conduits, the presence of which cannot be determined until the work has started; or imperfections, rotting or decay in the structure or parts thereof necessitating replacement. 7. Title to the item (s) sold pursuant to this Agreement shall not pass to the Purchaser until the r full price as set forth in the Agreement is paid to the Seller. 8. Delays in payment shall be subject to interest charges of 18% per annum, and in no event higher than the maximum interest rate provided by law. If the Seller is required to engage the services of a collection agency or an attorney, the Purchaser agrees to reimburse the Seller for any reasonable expense expended in order to collect the unpaid balance. 9. If any provision of this Agreement is pronounced invalid by any tribunal, the remaining provisions of the agreement shall not be affected thereby. 10. This Agreement sets forth for the entire transaction between the parties; any and all prior agreements, warranties or representations made by either party are superseded by this Agreement. All changes in this Agreement shall be made in a separate document and executed with the same formalities. No agent of the Seller, unless authorized in writing by the Seller, has any authority to waive, alter or enlarge this Agreement, or to make any new or substituted or different contracts, representations or warranties. 1 1. The Seller retains the right upon breach of this Agreement by the Purchaser to sell those items in the Seller's possession. In effecting any resale or breach of this Agreement by the Purchaser, the Seller shall be deemed to act in the capacity of agent for the Purchaser. The Purchaser shall be liable for any net deficiency on resale. 12. The Seller agrees that it will perform this Agreement in conformity with customary industry practices. The Purchaser agrees that any claim for adjustment shall not be reason or cause for Blackdog Sales Agreement, Continued Page 2 failure to make payment of the purchase price in full. Any unresolved controversy or claim arising from or under this Agreement shall be settled by Arbitration and judgment upon the award rendered may be entered in any court of competent jurisdiction. The arbitration shall be held under the rules of the American Arbitration Association. i ;" Accepted: Accepted: �%&O (BLACKDO (PU HASERI Accepted:,,�� (PURCHASER) Date: �Z Date: � ��+p ir-a�nman«�rczrlj �, BOARD OF BUILDINt;ffaclu!�"i License: CONSTRUC REGULATIONS TION SUPERVISOR Number. CS 0779 Birthdate: 06/15/1968 Expires: 06/15/2004 Tr. no: 77569 Restricted To: 00 PETER K COOK SR 38;GARDEN ST HAVERHILL, MA 01830 li L C Administrator j i ^ � __._ Joie �a�nmonu�aliJi o� <ltzuar�t�s�3 t Board of Building Regulation's and Standards HOME IMPROVEMENT CONTRACTOR Registration: 132816 Expiration: 04/06/2003 Type: Individual PETER K. COOK PETER COOK 36 GARDEN ST. • - GG ,w, �✓ HAVERHILL, MA 01830 administrator A Location At PU'`J d No. !' Date MORTM TOWN OF NORTH ANDOVER 9 Certificate of i Occupancy $ ss�cNust`� Building/Frame Permit Fee $ C) Foundation Permit Fee $ Other Permit Fee $ TOTAL $ PC ;04 ` Check # j / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: l/L1/ DATE ISSUED: SIGNATURE: ztt Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: V1%ei lQ 1 �'i 17 1.2 Assessors Map and Parcel Number: 60 � Map Number Parcel Number h rA )O J (f /"- 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Reqyired Provide Required Provided Re(lifired Provided —+ 11 1.7 Water Supply M.G.L.C.40. 34) . 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2- PROPERTY OWNERSHIP/AUTHORIZEDAGENT mIS'i:�il C �i 1(iCt; /n� N10 2.1 Owner of Record l h� KFC Name (Prifitj Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: I Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 "registered Home Improvement Contractor rr te, go a�( r-� Comp ny Nam l /11p , l Not Applicable ❑ Registration Number ��-�— 6)(l Address �j A �firlvZs2/>� 101 ��? -- Expiration Date Signature _ Telephone 00 rn X z O v rn t r 0 z M 90 a_ r v rn _r z 0 SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check as a ucable New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. ❑ Demolition 0 Other ❑ Specify ;5l; 0 Brief Description of Proposed Work: OAF 6 I SECTION 6 - ESTIMATED CnNSTRTTCTTnN CncTQ 1 Item Estimated Cost (Dollar) to be Completed bv permit applicant OFFICIAL USE ONLY <: 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) �• . 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number vr.a..aavi� is v TV 1IMJM IMM iiJMF1"X,l111V1'4 1V Dr %—%JMrLZ 1LU WnE14 I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 1 AX_ u-WU-77L4syc, rLy f-u/Aff I t, as Owner/Authorized Agent of subject property Hereby authorize_ to act on My (re alfL,-ui all matters relative w�rized by. is building permit application. ( Z �` 4V3 Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I 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 E/ r-29 1L!^C Siariire of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2 NIJ 3KD SPAN DMIENSIONS OF SILLS DIIv1ENSIONS OF POSTS 1 DIlb1ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS t SIZE OF FOOTING X MATERIAL OF CHMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE W f c North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: J PIP Tei 1 - L L s d Pl/l�m; � (Location of Facility) e - Signature of Permit Applicant /-Y-el, V Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector A 00 r The Commonwealth of Massachusetts Department of Industrial Accidents Orrice of lnvesUgadons Boston, Mass. 02111 Workers' Compensation Insurance Affidavit L) I am a homeowner performing all work myself. Please Print I am a sole proprietor and have no one working in any capacity Ea— I am an employer providing workers! compensation for my employees working on this job. Campari mama: �'� �2 / �/ /Lein l Company name: Address City: Phone �k Fdure to some coverage a required under Section 25A or MOL 152 can lead tothe imposition d aminal penaltles d,a flne up to;1,500.00 andlar ons yens' imprisanrrtent.as 11e0.108.chdl peoaRiedJn the I= dASTAP VMORK.oRRER.and.a.fln d-($IOOAM-Belay agaloat.me. I understand that a copy d this statement may be forwarded to the OMoe d lnvestiggdona d the DIA for covers" verMcation. I do hereby certfy uun�deerr the pains and penalties o/ pedury that the Irdbrmabon provided above is bw arid =md. Signature _ I .Cl/ Date2� Print name f 1�11l n tier Phone # J a� off w use only do not write in this area to be completed by dty or town dfiold' City or Town P ens! no Check d(immediate response Is required Building Dept p Licensing Board Contact person: Phone k p Selectman's Office Health Department Other Vol r lam W 3 W O LL W m O H V W 0 J J Q R�,, ui am c o o :'m C C r1 oa O � a C _ y OC O V C.3 x O v E chi U w w° v U w U w a°G w w a Cl) w , w°' 0 w a WU a o a cn o cE ui am L.Tv I CCM O•— ca C-0 'E m m � � � Z O� �3 .0 O CD o O Q o a cma C O CL 0 CD C Z ts CL V N! O C C � C cc h G w U) 19 W W 19 W W c o :'m C C r1 O � C _ y OC O V C.3 .n C m ea Lp O � O y ; o n E cy ,. o ... :..: H O C�1 tv 0) E o CIE y O.3O y : cm� o U3 E oCD � 0643 �=mom CD ac lb 7 dp= •.r m 0 CL CM C Q = m go • C d p N ~ 0 — 0 CO2 LU o *."C_ �•y _ '� � R C o W E CL .. ��y Z o U CL ID s �E=s o L.Tv I CCM O•— ca C-0 'E m m � � � Z O� �3 .0 O CD o O Q o a cma C O CL 0 CD C Z ts CL V N! O C C � C cc h G w U) 19 W W 19 W W