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HomeMy WebLinkAboutMiscellaneous - 995 FOREST STREET 4/30/2018 (2)\ c" o� o moo. b Scn J cn O M o r^ o � 0 7 Date ..`...�..0...�..�` ............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1 J This certifies that ...............� n i �P ........................................................................................................... has permission to perform .....���f l7� �'( ..!.[:,?...�:�!..n `f ................................... ... J wiring in the building of........, r,,,,,`%,�!. i at..............................!f F'`+ P ...........................:..............:..`1.................... ,North Andover, Mass. Pee.....li.1...v......... Lic. No.�i�!�.� ..�v!:�,�........e. ............:.......1... ........ ELECTRICAL INSPECTOR Check # 6�Y �7 � N -J I I q t a Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank Location and Nature of Proposed Electrical Work: (� t ,< !1-[ w 5 t9(rvo ti EC) 2d.^, Completion ofthe followinjz table may be waived by the Inspector of Wires. No. of Recessed Luminaires APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK of Total Transformers KVA \ All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 Generators KVA No. of Luminaires % (PLEASE PRINT IN.INK OR TYPE ALL INFORMATION) Date: 311/8,1111 o. o Emergency Lighting Satter Units No. of Receptacle Outlets D City or Town of. NORTH ANDOVER To the Inspector of Wires: FIRE ALARMS (N By this application the undersigned gives notice of his or her intention to perform the electrical work described below. No. of Gas Burners of Detection and No. Initiating Devices Location (Street & Number) No. of Air Cond. Total Tons V Owner or Tenant A Ott Telephone No. Owner's Address Heat Pump Totals:................'"......................."' Number Tons KW e` Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Space/Area Heating KW Local ❑ Municipal ❑ Other Connection Purpose of Building Utility Authorization No. - Existing Service a Uo Amps /)o / 2 YO Volts Overhead ❑ Undgrd ❑ No. of Meters — Security Systems:* No. of Devices or Equivalent New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent Number of Feeders and Ampacity No. of Motors Total HP Location and Nature of Proposed Electrical Work: (� t ,< !1-[ w 5 t9(rvo ti EC) 2d.^, Completion ofthe followinjz table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) FansNo. 3 of Total Transformers KVA No. of Luminaire Outlets No, of Hot Tubs Generators KVA No. of Luminaires % Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Satter Units No. of Receptacle Outlets D No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches i No. of Gas Burners of Detection and No. Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers p Heat Pump Totals:................'"......................."' 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 Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring. No. of Devices or E uivalent OTHER: V) dAttach additional detail if desired, or as required by the Inspector of Wires. n Estimated Value of Electrical Work: o ?no (When required by municipal policy.) Work to Start: 3/1 •� I y Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The r� undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify) I certify, tinder the tins anti penalties of perjury, that the information on this application is true and complete. FIRM NAME: _ /�i� SCS E(tc ��C • LIC. NO.:NN 3- A Licensee: Sc- 1-f �Iosr5 Signature�fa/�v--- LIC. NO.: 3101-1 S (If applicable, enter "exempt" in the license number line) Bus. Tel. No. - vk.a3 Address: al N o t l •'t 9,A, &'Cdr-lc.ku M A 01 X3 3 Alt. Tel. No. • *Per M.G.L c. 147, s. 5741, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent ISID PERMIT FEE. $ �1 Signature Telephone No. ,�- M ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed y on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 - Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act - Permit/Date Closed: Trench Inspection Pass [N Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS ON: Pass Failed Re- Inspection Required ($.) ❑ Y Inspectors Comments: Inspectors Signature: r,- Date: FINAL INSPE ON: Pass Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: ti l Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com 4 -- The Commonwealth of Massachusetts - Department of IndustriqlAccidiints Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Nalene (Business/Organization/Individual): zf l es-ef i(eC4f, L _. -6- Address: 6-Address: �/ �o /(�� �j• City/State/Zip:_ Xw , r'761 D /813 Phone #: '7d"/- 521- �3 Are you an employer? Check the appropriate box: 1. ® I am a employer with .;2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. JaBuilding addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roofrepairs 13. ❑ Other !Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Aomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:- Policy # or Self -ins. Lic. #: Li / 2 7 1S3 rq Expiration Date: Ai Job Site Address: �y� F << 5 4 S City/State/Zip: . A n Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lAvestigations of the DIA. for insurance coverage verification. Ido Hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: 1600 � Date: 31 1g I (`t Phone #: 7 91" S_r)- l- 0 (o 23 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone '•a Information and Instructions - Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, - express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have , employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of - Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Dep.attxnent of Industrial Accidents Office ofInvestigafions 600 Washington St7reet Boston, SLA, 02111 Tel # 617-727-4900 ext 406 or 1-877rMAASSABB Revised 5-26-05 Fay, # 617-727-7749 wwwmass.govfdia PO Box 55098 Boston, MA 02205-5098 617-951-0600 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: Insured: LEONARD A DUBOIS and DANA G DUBOIS Property Address: 975 FOREST STREET, N ANDOVER, MA Policy Number: HMA 0252713 Claim Number: BOS00058148 Date of Loss: 2/18/2015 Company: Safety Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Joshua Terenzoni Claim Examiner 4/3/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3287 Fax: (617) 531-6648 Email: JoshuaTerenzoni@Safetylnsurance.com Location qg.5f v� r�'� 5 No. J ') b Date NQRTM TOWN OF NORTH ANDOVER s Certificate of Occupancy $ �'�s'••° •'<� J,ksE Mu Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $� 1 Check # r ! 7L' 5 1 �M1(%� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATF4 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: 3 SIGNATURE. Building Commissioner for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: F?5- fo " S/ S rC05 r�/ ;� ! f Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS n Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private $/ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record M,`Kf 19adsIt' 9sS lroe f Name (Print) Address for Service: Sig aiu/ti`e' Telephone 2.2 Owner of Record: for Nadte Print Address Service: v Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ sJ-cve ©.C4. Ao-ki Licensed Construction Supervisor: 0 �� oC License Number f, 13 �X 3 S ` �ll/C� �"� /� z/ Add 7� / 111&re /d1 ✓ f-333 c Expiiration Date Signature Telephone 3.2 ReRistered Home Improvement Contractor Not Applicable ❑ F/ut Pt`(I,. Compagy Name P, 0 & oy 3 Nf--,11 o N /V / Registration Number 21e 4z -,m Addres ( 37T- 3 3 3� Expiration Date Si re Telephone �ry T M X Z O SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2'. Workers Compensation Insurance affidavit must be completed and submitted 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 ❑ 1 Existing Building Repair(s) 0 this application. Failure to r this affidavit will result Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. 0 I Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: Aema,� l A.), ,,ve.ov CereP"L' R"R New C-K'L-Y. t 13o.1"1 P/ I SECTION 6 - ESTYMATE.D CONSTRUCTION CMTC I Item Estimated Cost (Dollar) to be Completed bpermit applicant OFFICIAL USE ONLY 1. Building / C3?Jv a� (a) Building Permit Fee Multiplier 2 Electrical 1 S Uv• � (b) Estimated Total Cost of Construction 3 Plumbing dVV d -v Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Ob , OD Check Number aca.iiv1'4 is vwi'Nrx AU 1[1vK1L.A11UP1 lU DE IUMYLE IED WH IN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize S f U e C �, c. �ry G.� to act on My behalf, fil mZters relative t work authorized by this building permit application. III 301a`� Signature 'oT 2Aer Date -SECTION 7b WNER/AU/THORIZED AGENT DECLARATION I, 5-T vy� ©i �l � L /9/1 4 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 of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE r a 1 V The Commonwealth of Massachusetts Qj Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 - Workers' Compensation Insurance Affidavit Name . Please Print Name:0�� Location: /, FS' A ,- es City a .'f w �o v -el- Phone # 0 1 am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity Fl I am an employer providing workers' compensation for my employees working on this job. Comoanv name: OK 4 I. C, Address . P b 130 S City: N e -w /V Al 4// 4/, Phone #- �-•e M 9ke, -o« Address City: Phone # Insurance Co. Polio # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition d criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonmentas wedi.as.cbdl,penaMmin the faun da.STOP WORK ORDERand.a.fine d_(310100) -a day agaimt..me. 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 certdy pai apenalties ofpe 'u that the information provided above is true and correct. Date / 1` Print name s� c� [ �� Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permk/Ucensi ❑Check if immediate response is required ❑ Building Dept ❑ Licensing Board C] Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other 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: /'0 S S wit04^4�v (Location of Facility) Jk /� -- 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 ` 91te &mmiax� Board of Building Regula ions and Standards One Ashburton Place -Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 116688 Type: Individual Expiration: 7/6/2006 STEVEN PAUL DICHIARA STEVEN DICHIARA 68 WHITTIER ST NEWTON, NH 03858 DPS-CA1 qr* 50M -04/04-G101216 — tee v/ om�noo2lIJPQGL/L a� /�iaaaaciu�deli4 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 116688 Expiration: 7/6/2006 Type: individual STEVEN PAUL DICHIARA STEVEN DICHIARA 68 WHITTIER ST NEWTON, NH 03858 is Administrator Update Address and return card. Mark reason for chang 7 Address F-] Renewal 7 Employment 7 Lost Card License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 L� A 6� Not valid without signature r 077 ��� �✓�%zaaaciucaelta ,# n BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 055622 Birthdate: 06/11/1964 Expires: 06/11/2006 Tr. no: 472.0 -- Restricted: IG STEVEN P DICHIARA 68 WHITTIER ST G— { NEWTON, NH 03858 Commissioner CO) m m m CO) m E COD CD O 71 O y n' 0 y Im C7 CD CD CO) CD 0 CD O CD er N = CL Og m y = B M '� c -i z Go m � � 0. M ir N T =r CL n o m a0 m t o y Ism .• _ 7 O m 0: m O�0 O gd I c!n C =y A r aCL O b � mm� CL Q m N�♦ cy O y RSG Q iT1 C/)•c c q g; C m VQ? AE m N go 0 co ib`Q N o A C ti m COL-0 �• N Q �: .�..yy 1 MV Q m �q � . M '1 o �. C °' ro w ~ '71 to x 0 O a � � d c" 071 . M M lmq 0 9 0 c LX NO RTm �O 9 a s SSAcHUS� Date./!�—../— Pik TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. '.. .. ��,~.............::'. has permission to perform_=:= r :!'.='� ........ `........... . plumbing in the buildings of .................... at ..... ! ... ! l : -r. �' � ............Ndrth Andover, Mass. Fee.....Lic. No..�J.. y�. ,-,F�.......... PLUMBQf RPPECTOR Check # J�J� I k• I MASSACHUSETTS (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location q95 15 RresT 'g�- of New 1:3 Renovation [E:r Replacement APPLICATION FOR PERMIT TO DO PLUMBIP FIXTURES Date �a•'!-Cj�/ Permit #-42 ff Amount. Plans Submitted Yes No (Print or type) y J / Check one: Certificate Installing Company Name - ` '%%`gym �� 6J o� �olt t� E] Corp. Address U ��P d S a l S Partner. Business Telephone — '1 77 77 7,73 ffrFirm/Co. Name of Licensed Plumber: C 4 ?4 5 F lC r - (n 2 o� Insurance Coverage: Indicate the type of insurance coverage by c ecking the appropriate box: Liability insurance policy cl� 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 igna ure Owner ❑ Agent I hereby certify that all of the details and information I have submitted tered in above application are true and accurate to the best of my knowledge and that all plumbing work and installation71�®rmeW?d, Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Statuand Chapter 142 of the General Laws. VED (OFFICE USE ONLY Type of Plumbing License tceum er Master Journeyman ❑ Date......... .:� !.!i. '/.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that �..� ....:. ` ' ...: ..........I .............................. has permission to perform .. .............�J % ............... .............................. wiring in the building of. �<..�.�:�J...`...l.'L*...... I... ..:..................... T at .!...1 l J� ��„tl �!/J......................... , North Andover, Mass. ZFee.:�.L...... Lic. No. ........ELECTRICAL INSPECTOR Check # 3-31 i, � r N IV a 4 Commonwealth of Massachusett Department of Fire Services BOARD OF FIRE PREVENTION REGU TIONS Official Use Only ' Permit No. �� ; Z—ero Occupancy and Fee Checked �J . [Rev. 11/99] leave blank APPLICATION FOR PERMIJthe PERFORM ELECTRICAL WORK All work to be performed in accordance wsachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORDate: 12-8-2004 City or Town of. N. Andover To the Inspector of Wires: By this application the undersigned gives notice of hisention to perform the electrical work described below. Location (Street & Number) 995 Forest Street Owner or Tenant Mike Agosti Owner's Address "Same" Is this permit in conjunction with a building permit? Purpose of Building Kitchen remodel Existing Service Amps Volts Telephone No. Yes ® No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity 7- 20 -amp circuits Location and Nature of Proposed Electrical Work: Kitchen area and basement near electric panel. �..— uuueaiuieui ueiuu y aesirea, or as reguirea by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) 5/05 Estimated Value of Electrical Work: $1500 (When required by municipal policy.) (Expiration Date) Work to Start: 12-6-04 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Facilico. Inc. LIC. NO.: 15337A Licensee: Bryan Regan Signature LIC. NO.: 36113E (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 866.929.2100 Address: P.O. Box 3234 Wakefield MA 01880 Alt. Tel. No.: 617.201.4372 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ .� —i u uae uuuwtn tuote ma oe waivea b the Ins ector o Wires. No. of Recessed Fixtures 9 No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above El mergency ig ing rnd. rnd. d. Batte Units No. of Receptacle Outlets 8 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 4 No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges I No. of Air Cond. TotaTonal No. of Alerting Devices No. of Waste Disposers Heat Pump Number ""' Tons """ "" KW .................. No. of Self -Contained Totals: ""' Detection/Alerting, Devices No. of Dishwashers 1 Space/Area Heating KW Local ❑Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Water No.KW No. of No. of No. of Devices or Equi alent Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: �..— uuueaiuieui ueiuu y aesirea, or as reguirea by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) 5/05 Estimated Value of Electrical Work: $1500 (When required by municipal policy.) (Expiration Date) Work to Start: 12-6-04 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Facilico. Inc. LIC. NO.: 15337A Licensee: Bryan Regan Signature LIC. NO.: 36113E (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 866.929.2100 Address: P.O. Box 3234 Wakefield MA 01880 Alt. Tel. No.: 617.201.4372 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ Date. -.7.' . ��� .'..'..... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION - r. This certifies that ........��, ... ,.r.:. ..................... has permission for gas installation : T- :.......� ........ . in the buildings of ..... ............................. . at .. "9. � , � ...... , North Andover, Mass. Fee:.'.' ..... Lic. No...'l.`�............... GAS INS�EC7dF Check # % r :? a I s5\ MASSA G B USETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING Type) Mass. Date— j l,7 U�Peretti ' r # a Location-_ Name S✓A'a it sd/V Type of Occupancy ?e 0 Renovation ❑ Replacement o-- Plans Submitted: Yesp ' No [j ltnstalting Company Name z c tT Address tr R rid Check one: B—Corporation Certificate # - aC. i:� Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: 1 have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O if you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy EJ-- Other type of Indemnity ❑ Bond p C5WNER'S INSURANCE WAIVER: t 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. A Check one: Signature of Owner or Owner's Agent OwnerO Agent 0 i hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene at Laws. BY T e of Ucense: 11 Title Plumber r to e o c nse Plumber or Gas rtter — asfllor � �, i� City/Town;r)Jor aster License Number '7 ��C7lry_ Journeyman ------------------ I ®���®®���■r® ■ENNEN e�■®®n •• ■ME■ ONE ■®®EMENEEM■■,it��■ ltnstalting Company Name z c tT Address tr R rid Check one: B—Corporation Certificate # - aC. i:� Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: 1 have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O if you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy EJ-- Other type of Indemnity ❑ Bond p C5WNER'S INSURANCE WAIVER: t 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. A Check one: Signature of Owner or Owner's Agent OwnerO Agent 0 i hereby certify that all of the details and Information I have submitted for entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene at Laws. BY T e of Ucense: 11 Title Plumber r to e o c nse Plumber or Gas rtter — asfllor � �, i� City/Town;r)Jor aster License Number '7 ��C7lry_ Journeyman ------------------ e m m b a O O 33 m (4 N z U) v m -1 0 z w in r 0 '11 O 0 r ..h n in C W m O x r V m z Ga � n1 X -4 m O O s :s X N �► O m m �o e m m b a O O 33 m (4 N z U) v m -1 0 z w in r 0 '11 O 0 r ..h n in C W m O x r M N° J . t U f NORTH 1 Q t�.ao ,•a tiQ O p �,SSACMUS� Date .......... ..l..::� .....� TOWN OF NORTH ANDOVER PERMIT FOR WIRING p This certifies that ........ .. has permission to perform ........... ....... ,r' wiring in the building of ......................................................... at :i..... ..1..�.. .............. ...,./. ,North Andover, Massl Fee.., JU:.�o.... Lic. No.�.� f%` - j�:.::%Y zwl- ..� ./.. y ELECTRICAL INSP &R'-- Check TOR y Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ( .tonweaR of Mai-iac�Lwettt 2eRartmenl ol3im Service] BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Pernut No. E Occupancy and Fee Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfornied in accordance with the Massachusetts Electrical Code (NIEC), 527 CNIR 12.00 (PLE.LSE PRINT IN INK OR TYPE .ILL iNI---OR,11.11'ION) Date: 7 — 6--01 City or Town of: w(5po-q oyvpa rz To the Inspector of FY'ires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street R Number) q95 IF- aes 1 S Owner or Tenant M, Ki H(:.© _ Telephone No. 77P- - 4e8 / -IVV ` - Owner's Address SAME t Is this permit in conjunction with a building permit? Yes F1No ❑ (Check Appropriate Bos) Purpose of Building S r A/cf IC F/j-M r [u Utility Authorization No. C5 Z (0G i/ f Existing Service 10C) Amps 7 ?-0/ ZCIOVolts Overhead El— Undgrd ❑ No. orAleters 1 it New Service Amps 1 ?-0 / .WO Volts Overhead Ej�- Undgrd ❑ No. of Meters Number of Feeders and Ampacity 10 S W, Location and Nature of Proposed Electrical Work: C Completion of the follolvinn table mm, ht, wnh—1 No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of 'Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KN'A No. of Lighting Fixtures Slyimming Pool Above ❑In- ❑ rnd. grnd. 0.0 mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones slo. of Switches No. of Gas Burners No. of lletection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices a No. of Waste Disposers Heat Pump Number Tons I KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers S ace/Area Heatin K�V p g Local Municipal ❑ Connection El Other No. of Dryers Heating Appliances KW. Security Systems: No. of Devices or Equivalent No. ofWater KW KW No. of No. o!• i)aia Wiring: Heaters Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total I -IP •Telecommunications Wiring: No. of Devices or Equivalent OTHER: A ttach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COV COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ 0.1.11ER ❑ (Specify:) 6�7jr25(Z' TI>etW ) KS (Expiration Da /) Estimated Value of Electrical Work (When required by municipal policy.) Work to Start: �- G -O 1 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cer•tifj•, under tlr ^pains ani! penalties of perj►m)•, that the information on this application is trite and complete. FI101 NAAIE: `> Q0W I (IRA�( UCwc-- 4 � LIC. NO.: J 3 y4CJ%J Licensee: I\k \YG b—LL - t'-Y1ott Signature y// LIC. NO.: J �OCf 4 (If applicable, enter I.erenipt - in the license number lint.) b p f}1�i6 S+'' �1 t�(ieNC� �- l SL[ us. Tel. No.: s7�- 0 Address: 14 p d � Alt. Tel. No.:�• �' jr? 3- G, 6 L � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does mot have the liability insurance covera-e normally required by law. By my signature below, I hereby waive this requirement. I am the (check onc) ❑ oxvner ❑ o\11,uer's agent. Owner/Agent Signature Telephone No. PI:RtLIIT FEE: S �( PLEASE FILL OUT BACK SIDE BUILDING PERMIT 01CUED` .°,tip 3`� • •6 d TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINA ION * - Permit NO: Date Received Date Issued: /h/ / d C""sc� TANT: Applicant must complete all items on this LOCATION 3 9 5 Fore -4 S fres.+ ri t -r PROPERTY OWNER MlCk�2 l t J'�P,'tr A`io - T4 Print v MAP NO: 0 PARCEL:Clt�I ZONING DISTRICT: Historic District yesrno Machine Shop Village ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ® One family & Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Boij New AipSW 8eJ1?P-v,n ovcr OWNER: Name: Address: 0I 9 S Identification Please Type or Print Clearly) S�re_a.: �c�,, ��r_- A90S41, Phone: 975-6439- OSIS CONTRACTOR Name: ?.'/'389--333#1_Phone: sfo w" o�G%�, 14#114 Address: PO ZoX 3s6 tVeoioo MR. y3ys9 Supervisor's Construction License:/ Exp. Date: Home Improvement License: // 6 Exp. Date: .� /� //4/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT.- $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.60 PER S.F. Total Project Cost: $ S�/, OD -0 FEE: $ 6/ Check No.:� j w Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �'b -- Signature of contractor,_i�'r� A 4 I'—, D P Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this pate LOCATIO Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Arlriracc CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner .Signature of contractor Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ -stamped Plans ❑ Building Department The folk wing is"a Iist of the required -forms to be filled out for. the appropriate. permit to -be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ Ruilding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/0'r C.S.L Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apnoal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Bui?ding permit Revised 2012 Plans Submitted ❑ Plans Waive ❑ Certified Plot Plan ❑ Stamped Plans F1 'TYPE OF-:SEWERAGE:DISP,OSAL" Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc..- ❑ .-' : Permanent Dempster on Site ❑ THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING' & DEVELOPMENT' ❑ COMMENTS .CONSERVATION Reviewed on _ Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow:: Engineer: Signature: FIRE DEPARTML-,,iVT - Temp Dumpster on site yes_ Located -at 124 Mair Street - Fire Departine►it signature/date ` r - COMMENTS Located 384 Osgood Street no ' . Y .-Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area; sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL -Chapter 166. Section 21A --F and G min.$100-$1000 fine NOTES and DATA — (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Plans Submitted ❑ Plans Waived ❑ . Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tannmg/Massage/Body Art ❑ Swimming Pools ❑ Well Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMENTS DATE AP ROVED ia11y CONSERVATION COMMENTS r HEALTH COMMENTS %t% Zoning Board of Appe6A: Planning Board Decision: DATE REJECTED DATEAPPROVED No: Zoning Decision/receipt submitted yes Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street -A Fire Department signature/date COMMENTS y . 2y_/I,/ Location "/ '7l acz7' � r� No. — Y Date C TOWN OF NORTH ANDOVFER Certificate of Occupancy $ �.— r Building/Frame Permit Fee /' /-j Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #" • Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulafion Construction Cost 51,000.00 m $ - $ 612.00 Plumbing Fee $ 76.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 76.50 Total fees collected $ 865.00 995 Forest Street 573-14 on 2/3./2014 New Master Bedroom over Family Room J W z LL o O m Y O LCL EJ u a N O dIL z z 0 _ o LL s cC N c u f0 c LL O z z C C s w c LL O CL z J J LU s CLO W _u In c LL a N Z CA Q (' s CLOv m c LL Wc C Q W aW w LL ` c m Z ,U N {% ++ o Y O {n r� � U.J z 0 W �V ti PR • N E2 N o « Cc i O V F+ •Q. V CLcc ai d Q �: •� O V N d C O d r O E C v N C: cc OPP�: N J L m > M C ON O r a1 > N— 0 tm 0 cc ' t V Q -a N oL r d Z CL=y.. y C .: C E •p' 3 = o0 L QQ.a) w d .i r ' N .0 •N V O O C H CL 4) p N m U) 0 0 -a d Ii '� 3�N c N � w U a) v U) a� O -a m� Q- > c N O o 0v F=-- .m 0 n 0 W �V ti PR • N E2 N I, L RF/,Al Preferred, Inc. 451 Andover Street North Andover, MA (978) 686-5300 Toll Free: (800) 462-75 John Cusack Broker, Consultant 100% Club Direct Line: (978) 725-5355 Home Office: (978) 686-2000 Portable: (978) 815-1218 Fax: (978) 683-5577 Email: johncusack @ mediaone.net 995 Forest Street, North Andover $319,000 STYLE: Colonial ROOMS: 8 BEDROOMS: 3 BATHS: 2.5 GLA: 2,210 s.f. LOT SIZE: 50,094 s.f. MLS #: 30217841 DIRECTIONS: Corner Lot. Wildwood Cul-de-sac REMARKS: Talk about curb appeal: Picture perfect 8+ room colonial located on family filled cul-de-sac in the Annie Sargeant School District. Formal front to back living room features gleaming hardwood floors and brick fireplace. Formal dining room with crown and chair molding as well as formal wainscoting and sparkling hardwood floors. Eat -in kitchen with oversized pantry, light the flooring and plenty of cabinet and counter space. King size family room has hardwood floors under carpet, cathedral ceilings and walls of windows. Heated sun room features cathedral ceilings with ceiling fan, all PELLA wrap around windows, double sliders, and vertical oak strip walls. Upstairs boasts of 3 large bedrooms all with hardwood floors and ample wall and closet space. The master bedroom has his and hers walk-in closets as well as a full master bath. Beautiful wooded corner lot runs the entire left side of Wildwood cul-de-sac (please see plot plan on back side of sheet) and is complemented by flowering trees, bushes and gardens. STRUCTURE & RC7OIVf.S APPLIANCES SERVICES FINANC/AL & EXTERIOR FEATURES ...... . . :.:. _ .. 1977 Roof: LEGAL Foundation: Poured Concrete Kitchen-- 14:x-13 - Range: Yes Heat: HWBB Age: 1977 Roof: AsphaltDining Rm :12 x;131:;::::. Dishwasher: Yes Fuel: Oil Taxes: $3322.48 Ext. Walls: Clapboard Ltying Rm .:;14.x.24;::-,,;: Heat Tones: Two Tax Year: 1998 Basement: Yes Family Rm: l4 x 23 Electric: C/B's Assessment: $244,300 Windows: Storm Master BR: 12:x 19 Sewage: Private Zoning: R2 Screens: Yes Becirm 2: 11 x 12 Book: 3410 Floors: Wood; Tile: Carpet Bedrm 3: 12x 16 Page: 0063 Fireplaces: One Sunroom: 14 x 16 Owner: On file Deck: Yes SAC: 2.5% Garage: Two under BAC: 2.% Exclusions: Kitchen light and window treatments. Agency Disclosure All Brokers/Salespersons represent the Seller, not the Buyer in the marketing, negotiating and sole of property, unless otherwise disclosed. However, the Broker or Salesperson has on ethical and legal obligation to show honesty and fairness to the Buyer in all transactions. Realtor Disclaimer All information supplied by Owners. attempt has been made to verify some. Sales offerings � are made subject to errors, omissions, changeMLS- r of price, prior sole or withdrawal without notice. All room sizes are approximate too I�"""joo 'j 4.444 Milo Ir VMS ej fe 4p% �jj..�y�� 71,. �,y� M� '�•}�•" `5�►� � � � Cay /��, � `� ` tip,, •r • • . "` ':. ''ice •�.:j... ��� '�• ±,'• �� .��,/ Ir • , I • •� • • 40 1.1 • , ` y • . :4 +� . + ter• • v> (o 11 �'� �® CERTIFICATE OF LIABILITY INSURANCE/27/2014 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER INSURANCE SOLUTIONS CORPORATION 60 Westville Rd Plaistow NH 03865 CNAOMNTACT Og Linda Bdanowic2 PHONE(603)382-4600 ac (603)382-2034 -ADDRESS:lindab@iso-insurance.com INSURERS AFFORDING COVERAGE NAIC 0 INSURERA:Peerless Indemnity Insurance INSURED Steven P. DiChiara Contractor PO Box 356 Newton Junction NH 03859-0356 INSURER B Alla Mutual INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER-CL1412715129 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR North Andover Building Dept POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR Keith Maglia/LJB CBP8743045 2/30/2013 2/30/2014 EACH OCCURRENCE $ 1,000,000 DAMAPREMISES GES ( REEa occurreNTED nce)$ 100,000 MED EXP (Any one person) $ 15,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X1 POLICY PERLOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS r 1 COMBINED SINGLE LIMIT Ea a ident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLALIAB EXCESS LIAR _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I NPR PROPRIETOR/PARTNER/EXECUTIVE haa�EEXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA C -500-5012476-2013A /26/2013 /26/2014 WC STATU-OTH- 'I IANY E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE- EA EMPLOYEE $ 100,000 E.L. DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) project: 995 Forest St., N. Andover MA CERTIFICATE HOLDER cenlcrl I ATInu AUUKU Z6 (ZU'WIU6) INS025 fminn.i m ©1988-2010 ACORD CORPORATION. All rights reserved. Tha annRn nama and Innn ara ranicfamrd marine of A(`nRrl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. No Andover, MA AUTHORIZED REPRESENTATIVE Keith Maglia/LJB AUUKU Z6 (ZU'WIU6) INS025 fminn.i m ©1988-2010 ACORD CORPORATION. All rights reserved. Tha annRn nama and Innn ara ranicfamrd marine of A(`nRrl The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Business/Organi'zation/Individual): S ke ye c Address: P O r3 v X 3 5'G City/State/Zip: ►v ov, i� D 3 9-5-7 Phone #: iS-/- 3 ? �- 3 3 3 . Are you an employer? Check the appropriate box: 1. ® I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 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. E] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I L [] Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box#1 mustalso fill out the section below showing their workers' compensation policy information. t -Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: 1 K) $ SO /y Le— S j Policy # or S elf-ias. Lic. #: W c c - Y00- Expiration Date: % / a //y Job Site Address: 99-5 F&,,-esl <4, City/State/Zip: //ty, 7 ar^e►'' Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 cert the ains and penalties of perjury that the information provided abbove is true and correct. G Date: Phone #• 291- 30- 3 3 3,2— Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 6. Other - - - Contact Person: Phone 0: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer'is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a -deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. B e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be -sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in . (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be fillgd out each year. Where a home owner or citizen is obtaining a license o permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office oflnvestigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: `rho Commonwealth ofA4o sahusPtls Department ofMustrial .A.ccidows Office ofiuvesiigat ons 600 Washington Street Boston, MA 02111 `1`ol, # 617-72?�4 00 e 406 ox 1-87`��:NlA ASS Revised 5-26-05 Fax # 617"727-7749 v WW.Mus,&QV a Contract STEVE DICHIARA General Contractor P.O. Box 356 Newton Jct., NH 03859 MA LICENSE # 055622 • REGISTRATION # 116688 781-231-0768 • 603-382-6032 PROP $AL SUBMITTED TO r Y PHONE PHONE DATE ET ! / / i JOB NAME CITY, STATE and ZIP ODE JOB LOCATION ARCHITECT =DATELANS JOB PHONE We herebysubmit specifications anndd/estimates for: r r11 U Oh V I r C)Cir i /a- ��✓� / (/ r�S 1 P iDr C d h `r Me propose hereby to furnish material and labor — complete in accordance with above specifications, for the of: of: dollars meM to bede as follows: 1/4 I/�� / S 7L U llUlJ Qr ) Y� CL r cAll material is guaranteed to be as sped' . All w rk to be completed in a workmanlike Authorized � manner according to standard practices. Any alteration or deviation from above specifications Signature 14 involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or Note: This contract may be delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our withdrawn b if n t t d 'th' d workers are fully covered by Workman s Compensation Insurance. y US O aCCep a WI In ayS. Acceptance OL Contract— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the Signature work as specified. Payment will be made as outlined above. Signature Date of Acceotance: �G i y " d Office of Consumer Affairs and Buslness Regulation. 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 116688 Type: Individual Expiration: 7/6/2014 Tr# 226816 STEVEN PAUL DICHIARA _ +''• STEVEN DICHIARA 68 WHITTIER ST NEWTON, NH 03858 �A- r Y = v Update Address and return card. Mark reason for change. t ❑ Address Renewal [:] Employment Lost Card SCA 1 20M-05/11 &2. �poo,vrw�ccuec�ea�acl��eLta License or re istration valid for individul use only Office of Consumer Affairs & Busi ess Regulation g Registration: OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ,1 X6688 Type: Office of Consumer Affairs and Business Regulation xpiration: 7/6%2014 Individual 10 Park Plaza -Suite 5170 Boston, MA 02116 STEVEN PAUL DICHIARA . STEVEN DICHIARA 68 WHITTIER ST gsa3 NEWTON, NH 03858 Undersecretary Not valid without signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen•isor 1 & 2 Famih• License: CSFA-055622 STEVEN P. 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