HomeMy WebLinkAboutMiscellaneous - 927 JOHNSON STREET 4/30/2018 (2)N
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3632 1 e- 2—
Date, <Y— ....................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that .............................. : ........... ..............................................
has permission to perform ...............................................................................
wiring in the building of ....... ............. ........................................
at .......... .......... ......... . North Andover, Mass.
4
Fee.,—:?.1 ............. Lic. No ............... ...............................................................
ELECTRICAL INSPECTOR
Check # k-
SIN
T1MC0 V10A WE4LTHOFMMCFIL1SEM Office Use only
DEPAR73JUDN1'OFPUBLICS4FRY Permit No. -3
BOARD OFFIREPREVEWONRhiGULATIOUS52 GC fflIM
Occupancy & Fees Checked
APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL 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 - 1 - Q Z
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) q
Owner or Tenant ,(gj [r L S ,?V6 L4
Owner's Address S m
Is this permit in conjunction with a building permit: Yes CONo (Check Appropriate Box)
Purpose of Building ()J C--(, L, I 'N ( y C Utility Authorization No.
Existing Service Amps—..L—Volts Overhead Underground � No. of Meters
New Service Amps / Volts Overhead Underground E No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work E�-v��tT/�yJ D Zdd mrj ,G3t✓U/ Gr
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
K.VA
No. of Lighting Fixtures Swimming Pool Above Below Gene a m KVA
and around
No. of Receptacle Outlets No. of Oil Burners No. ofEntergency Lighting Battery Units
No. of Switch Outlets
0'HER
ltm>ranoeCot� Pustrattbt#letagtiana�of�d>t>ee�Gataailaws .
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iddotmysign mcnthispttiappfica6mwainfinstegtta Wt
'lease check one) Owner Agent
1 Telephone No. PERMIT FEE
No. of Gas Burners
No. of Ranges
No. of Air Cond.
Total
FIRE ALARMS
No. of Zones
Tons
NW. of Disposals.
tPwnp
No. of Heat
Total
Total
No. o(Detectionand
T06
KW
InitiatingDevices
No. of Dishwashers
Space Area Heating
KW
No. of SoundinZ Devices
No. ofSelfCoNained
Detection/Sounding Devices
No. of Dryers
Heating Devices
KW
Local Municipal
Other
No. of Water Heaters KW
No. of
No. of
Connections
Signs
Bailasis
No. Hydro Massage Tubs
Na. of Motors
T A.1 uv
0'HER
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'lease check one) Owner Agent
1 Telephone No. PERMIT FEE
0 �;
Commerce
f N S U R A N C E -
September 12, 2014
The Commerce Insurance Companysm
Citation Insurance Companysm
11 Gore Road, Webster, Massachusetts 01570
508.949.15001 www.commerceinsurance.com
BUILDING COMMISSIONER or
INSPECTOR OF BUILDINGS
TOWN/CITY HALL
NORTH ANDOVER MA 01845
Board of Health or
Board of Selectmen
Town/City Hall
RE: Our Insured: WILLIAM G SIROIS / ELLEN A SIROIS
Property Address: 927 JOHNSON ST
Policy#: Y71302
Date of Loss: 09/05/2014
File#: JMRC36-CYYAY8
Claim has been made involving loss, damage, or destruction of the above captioned
property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143,
Section 6 to be applicable.
If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to my attention. Please reference the above captioned insured, location,
policy number, date of loss, and file number on any correspondence.
LISA LEAHY Telephone: (508)949-1500 Ext: 15846
Sr Claim Representative, Property Toll Free: 1-800-221-1605, Ext: 15846
On this date, I cause copies of this notice to be sent to the persons 'indicated above, at the
address above, by first class mail.
September 12, 2014
Damage to deck. Large deck on home that has started to settle, sink,
collapse. Damage to support beam. Maybe due to weight of ice and
snow over winter.
CIC 254 (Rev. 4/95) MAIL 788
DateA?-.4-09...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies ........ ....... .........
has permission to perform ..........
.............. . ............................................
I (i
wiring in the building of ................................................
............... . North Andover, Mass.
................... I ......
Fee'��—( ... . .... �'Lic. No . ............. ....
... EE
Check #
851
M
r— - CJtiicial Use Only
' � �;,,��:,��• of r�as�.�.� . :.
Permit No. ..�
WKS�/J.Parf„�.nE o� J`ir• �.rvi'cd .. / cw ...
Occupancy and Fee Chcek4 • -
SOARD,OF FIRE PREVENTION REGULATIONS (Rev. 1/071 leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All wo� to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PFdNT IN INK OR TYPE AL .INFORALiTIOA9 Date:
City or Town of:��� To the Inspector of Wires:
Its notie-- of his or her intention to perform the electrical work described below.
By this application.the undersigned giv
Location (Street & Number) %2 % ��?yn �✓
Telephone No.rj7s:627-M
Owner or Tenant /,J, L fo (� (0 - S /-
Owner's Ad¢r -IS
is this permit in tconjunction with a building permit? - Yes ❑ No =- _ Check. Appropriate Boz)
Purpose of Building Util',ty Authori-7.Atien No, _
Existing Service Amps / Volts Overhead [jUndgrd E] No_ of tYl-I
New Service Amps / Volts Overhead ❑ Undgrd LJ No_ of Meters
Number of Feeders and Ampacity:
Location and Nature of Proposed EIectriml Work: J�� p �� Q�► a , J �Gu r -t a r re orf'
S-reirl
nrfj. rnlinwew /nh1e ,-.rev he waived 5v the /nscector ofWbvs.
. •
- ..."...," ----- - --- - -
�n=-t
o.
No".of Recessed Luminaires
No. of ceiL-Susp. (Paddle) Fans
Transformers ievA
info. of Luminaire Outletr
No- of Hot Tubs
Generators KVA
No_ of Luminaires
Above n-
Swimming Pool rnd. grnd.
NZ. of r,►ergency tg ti
Biaery Units
No. of Receptacle Outlets =
No. of Oil Burners
FIR�'ALAR�MS
No_ of Zanest
e.
No. of Switch es
No. of Gas Burners
::i'iatina Devices
No. of Ranges
etat
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
eat ump um erons ___
Totals-
o. o e - ontarne
Detection/Alerting Devices
Space/Area Heatirid KW
lY untetpal ❑ Other
Local []:ronnectior.
No. of Dishwashers
Heatin g Appliances KW
utyT ystems—
e:n
No. of Devices or Equivalent a
No. of Dryers-
No. o. o Water KW
o_ o o. 0T__
Ballast`
Data Wiring:
No. of Devices cr E uivsl_nt
Reaters-
Signs
No. -Hydromassage Bathtubs
of Motors Total HP
Fe ecommunicarions icing:
No. of Devices'or Equivalent
�No.
OTHEF2: �� / g^a`Y I
r j a x 1. / icing n%Wtr[S
�• gtraclg aaaruanar uaau uuucu v, — ,may.... �.. _,r ....—
Estimated Value ofElcc cal Work: `0' f9� _ (When required by. munici-jal,policy--)
Work to Stara /()/ Inspections to' be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unlesswaived-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
tiddersigned certifies that'such overage is in force, and has exhibited proof ofsame to the permit issuing office.
CHECK ONE: INSURANCE IN BOND: ❑ '. OTHER ❑ (Specify:)
I certify, under the pai/u and penalties of perjury, that the information on this application is t: ue and complete,
SGC'�J(t'.PS � � 5'3 � .�
FIRM NAME: �'iqq S�C•ur[-� -
Licenser. 1�(y[ �t {1/O�i Signature• �-
/ o lieable, entre "e p[" in the licurs� /rum er lute Bus. Tel_ No.: 59
H a.3a�9
(' pp / l/t.s AIL T_L No.:
Address: o G ! 9
*Per M.G_L. c. 147, s. 57-61; security work requires Department of Public Safety " S'' License: Lic. No. S Ce
OWNER'S INSURANCE WAIVER ( am aware that the Lieet..see 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),[] ovtrtcr [I owner's agent.
Owner/Agent :.Telephone Nc. EPERMIT FEE:1�
Signature
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Location
No. Date 4
'73 CHUS
Check #
153-15
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
re
,-7
Building Inspecto 57
TON" OF NORTH ANDOVER.
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR. RENOVATE. OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED: /3-0402.
� O Z
•
SIGNATURE:
Building Commissioner/Ispector of Buildings Date IL . IJ•
SECTION 1- SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
A' Ori0,�). / 2—
1.3 Zoning Information: 1.4 Property Dimensions:
Zonin District Proposed Use I of Area I.AFronta ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
I Reauired I Provide I Reauired I Provided I Reauired I Pravic>ed I
1.7 water Supply M.GJ-C.40. 54) 1.5. Flood Zone infomvtion 1.8' Sewerage Disposal System:
Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ Ou Site Disposat'System 11
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2:1 Ownerof Record
Name (Print) Address for Service:
Signature Telephone
2.2 Owner of Record: fel o>zt-kyr-t
Name Print Address for Servrce:
/ t/ d/ �� KI -57 Y�-1
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable . ❑
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
Not Applicable ❑
Registration Number
Expiration Date
SECTION 4 - WORKERS COMPENSATION (1VLG.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit m be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildi nnit.
Signed affidavit Attached Yes...... No ........ 0
SECTION 5 Description of Proposed Work check all a ble
New C �tio + IIL\ e )sting Building Repair(s) 0 ;Mtts(s) ❑ Addition 0
Accessory Bldg. ❑ Demolition 0 Other 0 Specify
Brief Descrip rV(AX �Vo Now^
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed by permit applicant
l . Building (a) Building Permit Fee
o�
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee (a) x (b)
4 Mechanical AC
5 Fire Protection
Total, 1+2+3+4+5 ,.. iZ Check Number
SECTION 7a OWNER AUTHO ION 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 OWNFR/AUT140R1ZFD AGENT DECLARATION
I, RA k -f Z11 as Owner/A thorized Agent of su ject
—T
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
..1")
Si ature i r/A t
NO. OF STORIES
Date
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TDABERS 1 sr
2 No 3 RD
SPAN
DINIENSIONS OF SILLS
DIMENSIONS OF POSTS
DtIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CH ANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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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:
k�-
(Location
racuiry)
nature Lof 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
,ul
Board of Bnildi:i ; Regul.tions and %ndardE
HOME IMPROVEMENT CONTRACTOR
-9,
Rsagistration: 126593
EaairaJon< Q8,10W0C2
Tyne. SUpplemsnt Card .
Home Depot At -Horne Servic-�s
MARK AUDETTE
3260 �'06B GALLERIA PKVVY`#26
ALTANTA, GA 30339 Administrator
0
e
x CERTIFICATE OF LIABILITY INSURANCE I om2
rlacllm Sarial alt A1339 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
SHEPARD & SCOTT CORP. ONLY AND CONFERS NO RIGHTS UPON TIME CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
352 SEVENTH AVENUE - SUITE 805 ALTER THE COVERAGE AFFORDED BY THE POLICIES 8E
NEW YORK, NEW YORK 10001
INSURERS AFFORDING COVERAGE '
mauno _ __� _ _ wsum.R A: GREAT AMERICAN INSURANCE COMPANY
RMA HOME SERVICES, INC. INSURER B: AMERICAN ALTERNATIVE INSURANCE CO. -
3200 COBS GALLERIA PARKWAY NSC:
ATLANTA, GEORGIA 30339 INSURER D:
i INSURER E:
COVIFRAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
I�
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUjw OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS tom} CONOg10NS:�Stipi,
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED B-Y--P-%JD�CLAR.A&--- :: -:--... -- _ � -
ft YYM OF INSURANCE POLICY NUMEER l ►A�JCY EF CTN� UMTS
QW111Y►LLUEILITY
EACHOCC<IaMvNm s 1,000,000
I m DAMAGE (h y am A*) 6 100,000
A
X GCI mERCIAI OENE m VAwu'rY
CLAIMS MUM l X OCCUR
PAC 902619'36
I 03/10100
03/10/01
MID EXP (MY am person) s 5,000
�
PERSONM.aAIN IwurtY s 1,000,000
GgNffILALAQAMGATE $ 2,000,000
rAN'LiGGREGATELIMITAPPGESPER:
PRODJCT&-CCIMP)OPA00 S 1,000,00
X PDIJC'Y PRO.LOC
A
AUT011"LaUANLJTY
X
Aw AUTo
CAP 9026937
03/10/00
03/10101
CCIMMIM) I1lIT 1,000,000
(ft *wM .
ALL OwNEO AUTOS
SC)*Di REO AUTOS
EOpLY 0L1U9l9f E
mw PMeaq
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NCk-tlMYIJEO AUT06
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f UMB 9026938
03/10/00
03/10/01
EACH 000L4W CE $ 10,000,000
AGGREOAT! ; 10,000000
s
M�I;UCTiMMIrE
s
X RETENTION ; NONE
;
w71LKERSCCMmumTMONAm
20A2 WC 0007353-00
03110/00
03/10/01X
awwywIJAWTY
_
E.L.EACMAA ;100,000
E.L. an"" • EA ampLom s 1001000
E.L. DISEASE - POLICY LIMIT IT S 500,000
OTHIIR
D66GMKP.$.9�d10fiAf4®{rATK>IMS10tTMGLiBIkICGWilUP4s AD[�D 6T RirRVF:gG Mi@;.�rsr=acwc nwrs�.s
i'YE HOLaR X A=TIONAL.INSUPIEa
.,INSURER IEITMiIs CANCELLATION
.. +� SHOUTA ANY OF TM A§OW PAORINIIp POUGS& W CAIrCELLIITj aWo ME TIEI EXPYIIAT"
PROOF OF INSURANCE OATI TM REOF, TME tISIAMOSUR9t VIAL ENNAVM TO w L, _ 30 DAYS. vmrm
U071011TOrPSCUPW AODM NAMED TO THE LEFT, EMJI' FAILLE To Do SO OV
LL
IMPOW NO OlUOATION OlAftTY OF ANY KIMO woN TM EM Ls k In AGOM CR
n
3
Location V
No. Date -0-2
Th TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
CHU Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ c)
Check # /o/
5339 building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
PERMIT NUMBER: , �/ ca. DATE ISSUED:
SIGNATURE:
Building Commissioner/Ins=tor of Buildings Date
SECTION 1 -SM INFORMATION
1.1 Property Address:
9,27 John Sd4 Sf
V A, J,).oder
1.3 Zoning Information:
1.2 Assessors Map and Parcel Number:
�c)'7 q Z
Map Number Parcel Number
.Lot
1.6 BUILDING SETBACKS ft
. Front Yard Side Yard Rear Yard
Required I Provide I Required I Provided Required I Provi�dl
1.7 water supply MGJ—C.40. 54) 1.5. Flood Zan Information: 18Sewerage Disposal system:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On site Disposal system ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service:
�,6 76
Signature Telephone
2.2 Owner of Record:
Name Print
I
Address for Service:
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Cons6trction Supervisor. Not Applicable ❑
T a ,t a ( ((
Licensed Con�ssttrucaon upervisor:
/ ' / �/� S % �' � �� 06, 0/ Yq C% License Number
Address / G
Expiration Date
Sr{n Telephone
3.2 Registered Home Improvement Contractor
�17> (�' C0f5f�vc��d�
Company Name W
8- 2--12 z u
Not Applicable ❑
Registration Number
Expiration Date
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 building permit.
Signed affidavit Attached Yes .......❑ No.......❑
SECTION 5 Description of Proposed Work cheek all a hcable
New Construction ❑ Existing Building ❑ Repair(s) ❑Alterations(s) ❑ Addition 0�-
Accessory Bldg. ❑ Demolition . ❑ Other ❑ Specify
Brief Description( of Proposed Work: 9
i1 `e L✓ Gty Cy' S CJ vl Vtl Ce
Item Estimated Cost (Dollar) to be
Completed by peimit applicant
1. Building (a) Building Permit Fee
t Multi lier
2 Electrical it(b) Estimated,Total Cost of
Construction
3 Plumbin Building Perntit fee (i) x (b)
4 Mechanical AC
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
CT.c-rTnN 7h AWNF.R/ATTTFTnRT7.Rn AGMT DRCLARATION
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
a
Print Name
Signature of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 sr 2 NO 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL. OF CH VINEY
IS BUILDING ON SOLID OR FI1,LED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
D. Robert NTicetta,
Building continissioner
l
TOWN OF NORTH ANDO R
Office of the :Budding Department
Community development :axad Services
27 Charles Street
North Andover, Massachusetts 01845
DEBRIS DISPOSAL FORM
Telephone (978) 688-9545
FAX (978) 688-9542
In accordance with the provisions of MGL c 40 s 54, and as a condition of
building permit # the debris resulting from the work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c
11, s 150a.
The debris will be disposed of at / in:
( 2 �� s �c, D � (1:>0 5 fo
—(Site location)
permit
Date
Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diozzi, Gas/Plumbing Inspector
� lee -9om nomzwW,% oo✓liaaarlucael!
f = BOARD OF BUILDING REGULATIONS
Licerme: CONSTRUCTION SUPERVISOR
Number: GS 063604 III'
Birthdate: 10/30/1971
- Expires: 10/30!2002 Tr. no: 3003
Restricted To: 00
JOHN Q CAMPBELL
- 15 MILK ST
METHUEN, MA 01844
Administrator {
lcofffflew
=_ Registration 123359- `
Type - DBA '
Expiration 02/05/99
JBC CONSTRUCTION
F
' JOHN 0. CAMPBELL
CRESCENT AVE i
AMMSTRaroR LROSE MA 02176
TO:
JBC CONS
15 Mil
METHUEN
(978) 989-0038
Bill Sirois
927 Johnson Street
No. Andover MA 01845
We hereby submit specifications and estimates for:
1
10 1
PAGE NO. 1 OF 1 PAGES
PHONE
--R NM6
927 Johnson Street
No. Andover, MA 01845
JOB NUMBER
DATE -
_2/10/02 --j
JOB PHONE
U-0flomm.
Build new "A" dormer for entry way with flared rakes. Dormer will be 15 feet wide by 18
inches deep, roof height will be determined by existing roof. Install 4 sonar tubes to
support walls of new dormer. Remove existing brick siding and front entry way. Move 2
existing entry lights onto walls of new dormer. Furnish and install new 515" wide by 614"
tall Andersen Springline Specialty arched window with Renaissance grill. Furnish and instal
new Stanley steel arched window door with 2 new side lights. Install new clear pine interio
finish on door and window. Paint or stain is to be done by other. lte,uIDd�
Build new "A" dormer with flared rakes on garage to be as wide as existing garage door with
new Andersen 4 foot half round window in center of dormer. Front wall of garage and the
dormer are to be flush. Change shape of existing garage door to 45 degree angles on top
right and left corners.
On back side of house build new 16" by 16' wide roof for existing awning. New roof will
match the house. New wall flashing will be installed.
Install 2 new vents for existing bathroom fans in soffit.
New dormers and awning roof are to be framed for new siding.
the siding is done.
600 t GU I a.t V'-�x '--L� a "'O"e
1f
Tyvek will be installed until
.4v 4
\Ye Propose hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of:
dollars ($ 17, 100.00
Pay f=nY %@e
$8,000.00 at signing of contract. $4,500.00 completion of "A" dormer on front of house.
$3,000.00 completion of garage dormer. $1,600.00 completion of work on this contract.
All material is guaranteed to be as specified. AN work to be completed in a professional
manner according to standard practices. Any alteration or deviation from above specifica- Authorized
tions involving extra costs will be executed only upon written orders, and will become an Signature
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Note: This proposal may be
Our workers are fully covered by worker's C xn
eation insurance. withdrawn by us it not accepted within 20 days.
Acceptance oflProposal— The above prices, specifications and
conditions are satisfactory and are hereby accepted. You are authorized to do the work Signature
as specified. Payment will be made as outlined above.
Z
Date of Acceptance: ���� � Signature
MWOUCT 13121 FOLD AT rpt TO rrr COSPAMM M OU-0-YUE EMYETOK pr4mm IN ul A B
Received: 2/27/02 12:28PM;
-> Private; Page 2
1-TI/!� Y^]Il. ACO OIIC'C • '7 /'7
AC®RD., CERTIFICATE OF LIABILITY INSURANCE
02/27/2002
PRODUCER (508)651-7700 FAX (508)653-8089
Allied American Insurance Agency, Inc.
233 W. Central Street
Natick, MA 01760-3714
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.
INSURERS AFFORDING COVERAGE
INSURED John Campbell
DBA: J B C Construction
15 Milk Street
Methuen, MA 01844
INSURER A: Arbella Protection Ins Company
INSURER B: St. Paul Insurance Company
INSURER C:
INSURER D:
INSURER E:
nnveeAr_cc
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD
POLICY EXPIRATION
DATE MM/DD
LIMITS
GENERAL LIABILITY
8500019591
11/01/2001
11/01/2002
EACH OCCURRENCE $ 1,000,00
FIRE DAMAGE (Any one fire) $ 50,000
X COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person) $ 5,000
CLAIMS MADE F�] OCCUR
PERSONAL & ADV INJURY $ 1 000 000
A
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY PRO LOC
JECT
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT $
(Ea accident)
BODILY INJURY
(Per person) $
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per accident)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESS LIABILITY
EACH OCCURRENCE $
AGGREGATE $
OCCUR a CLAIMS MADE
$
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
TO BE ISSUED DIRECT TO
10/30/2001
10/30/2002
TORY LIMITS ER
E.L. EACH ACCIDENT $
EMPLOYERS' LIABILITY
YOU FROM THE CARRIER
B
_
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
i
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
OB: Construction of 2 new dormers
I_ryx I IrII.W I C r'IVLwr_n I NUU UNAL 1NV UKCU, I .a 1I --
Town of North Andover
Rebecca
North Andover, MA 01845
ACORD 25-S (7/97) FAX - (978)989-066]
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Rose Ross
1988
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