Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 118 Kingston Street
l 118 KINGSTON STREET 2101023.0-0006-0118.W l w 6 Date............. .�.".�... ,ti TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUSE� i This certifies that ............. T�r >` ����� &6&e-/ ........ ...................................... . .............................. has permission to perform ........... ............ ................................................. wiring in the building of..............(....J'b...G!�X{�I'9 ........................................................ at............. r�,/.Q..:............... ,North Andover,Mass. ........ . . ........... Fee. .f� ... Lic.No.I.�.�.`' .. ..... ..... :� ��.f.:.,� ..• ..... ELECTRICAL NSPEC`TOR Check # f-* 17tl 4. -. 11 Dater. �/� �`S�• ",o RT:'�o TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING 'S-1 CMUS� This certifies that • • • • • • • has permission to perform 'f :11. . . . . . . . . . . . . . -� . plumbingin the buildings of ! 4-. . . . . . . . . . . . at • • • • • • • , North Andover, Mass. Fee /�. . .Lie. No:�c'� ?7 . . . . . . . . ..a��-� . . . . . . . . . . PLUMBING INSPECTOR Check # 6756 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date V6�p Building Location ������r, q Owners Name �� ZR� c pzit# I Amountt�f,� Type of Occupancy i New Renovation Replacement 1:1 Plans Submitted Yes ❑ No ❑ FIXTURES Z H >� � a A4 O H a A4 o Z 3 a w W d W w a Z a a O QQ a � a Q > x z SLRBM �. x w RASB yr 1R FLOOR 3M FLOOR 4M FLOOR ^' 5 FLOOR 6IH FLOOR 7M FLOOR SIH FLOCR -Ell (Print or type) l Check one: Certificate Installing Company Name Corp. 5 3.5 Address Partner. e Business Telephohe Firm/Co. Name of Licensed Plumber: r ca Insurance Coverage: Indicate the e of insurance coverage by c ecking the appropriate box: Liabilityinsurance nsurance policy Other type of indemnity 11 Bond N tY 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 Owner11 Agent ❑ I hereby certify that all of the details and information I have submittedentered or above( )in bo e application are true and accurate to the best of m knowledge ge and that all plumbing work and installatigps performed under ermit Issued for this application will be in compliance with all pertinent provisions of the Mass achus State Pl g Cod Cha ter 142 of the General Laws. By: ure o Llcense um er Title Type of Plumbing License City/Townicense NumDer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Commonwealth of Massachusetts Official tJseOnly Permit No. � Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9!051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A-liivork to be performed in accordance with the rvlassachusetts Electrica7. .� C). 527 CNI 12(PLEriSE PRINT IN INK OR TYPESILL INFORnGI TION) Date: City or Town of: &/0 To the hupector ol'Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) tC) f/ Owner or Tenant �'c cc tC, �Gt tni\ Telephone No-17 /07 03 Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Bos) Purpose of Building—LO n d Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: —x i--� k, encA\4--, Completion(y the fnlloiving sable inav be waived by the his ector No.of Total of ll'ire.r. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No. of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: _ Detect ion/A lerti ngDevices No.of Dishwashers Space/Area Heating KW Local ElMunicipalConnection El Other No.of Dryers Heating Appliances KW Security Systems:* � y No.of Devices or Equivalent ( No.of Water -5-0—.of No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No. Hydromassage No.of Devices or Equivalent OTHER: < ("� �--� Ittarh additional detail if destred, or as required by the Inspector of Wires. Estimated Value of lectrical Work: (When required by municipal policy.) Work to Start: ` -�?- --?� Inspections to be requested in accordance with MEC Rule 10.and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation'*coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [✓BOND ❑ OTHER ❑ (Specify:) '��s� `�--- I certify,under the pains and penalties of perjury, that the in/i�rnrnlion an this application is true and ca ) te. FIRM NAME: G--� . NO.: Licensee: )K--eh re cJ y Signature ,�- LIC. NO.:3L(g 30 C (1l'applieable,enter "eccntpt"in the license number line. 7 Bus. Tel. No`s Address: 1t7 77 v cV!a n `� fi e��kJef-\ 1 v 2,144, Alt. Tel. Nod?9t *Security System Contractor License required for this work, if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee sloes 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 PERIWT FEE. S Signature Telephone No. Commonwealth of Massachusetts Official Use 011k, _ - FOCcLlpancy ^Y O Department of Fire Services ti nd Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9'05] (cave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK t q\II'\\ork to be perton1ied in rd:u accolce 1\ith the\lassachusctts l:lectrd C icroL1c(\IEC).5'_7(Al I x.00 (PLEASE PRINT IN INK OR TYPE.-ILL INFORMATION) Date:��� (Al -�-, Citv or Town of: tv;�� -\& To the Inspec'Inr of iVires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location (Street& Number) Owner or Tenant qt r t C t C, Telephone No.5 Owner's Address Is thisp ermit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Cav�C. Utility Authorization No. Existing Service Amps l Volts Overhead ❑ Undgrd❑ No:of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the foltou ing table nmv he ll,aived by the lns peetor of II'ires. No. of Total No.of Recessed Luminairesq f Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outletsf Hot Tubs Generators KVA Above o.o mergency ig ing No.of Luminaires mming Pool rnd. ❑ rnd. Batter Units E ALARMS No.of Zones No.of Receptacle Outlets 3 No.of Oil Burners F1R i i No. of Cas Burners No.of Detection and No.of Switches � Initiating Devices Total No.of Ranges No.of Air Cond. Tons 11No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Co tained i --- No. of Waste Disposers Totals: Detection/Alerting Devices 1Municipal No.of Dishwashers Space/Area Heating KW Local❑ Connection E] Other I Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent } No.of Water KW No.of No.of Data Wiring: Heaters signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No.of Motors Total HP No,of Devices or E uivalent I OTHER: �� eA.Cid 111ac17 nddilional detail /i .lesired, or as req d h uirer the hgaperhn_of Wires. ! I Estimated Value of kilectrical Work: (When required by municipal policy.) Work to Start: ' �?_ _7;� Inspections to be requested in accordance with \IEC Rule 10, and upon completion. 1 INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability instil•ance including-completed operation"coverage or its substantial equivalent. The un�lersi�ncd certifies that such cover��e is in tierce,and Ilas :xhibited proof of sante to the permit issuing office. i 01ECK ONE: INSURANCE ZBOND ❑ O FHER ❑ (Specify:) ,_`� 1 cerli/j;,under the pains tint/penalties of pery'urh, that the i . ination on thk application is frac ung/cu !e. { FIRM NAME: `i 1 ecC--A r . °' NO.: 7 Licensee: ,\ e v�v-,,e C ,i Signaturep,J L, 1-i(t{so [ Il/ 1pi'licuble, ,tiler 'excmpl"in the license munher!,ne. Bus. Tel. No`3 75' L•/ Address: kkSd rx '5' jl�e� �r�� tt� �v `f 4 Aft. Tel. Nod 71? "Security System Contractor License required for this work, iFapplicable,enter the license number here: OWNER'S INSURANCE WAIVER: I ant aware that the Licensee dots nut have the liability insurance coverage nurnrtlly required by law. By my signature below, I hereby waive this requirement. I am the(check one)[:] owner 1:1owner's,gent Owner/Agent PERMIT r,E E: S Signature Telephone No. �,�� e�� �` �� �o � �� 4 /n Location �f �/G S7d�4 f No. Date �ORT� TOWN OF NORTH ANDOVER Of "•O '•,�O 0 AL � 9 Certificate of Occupancy $ E<� Building/Frame Permit Fee $ sACMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2- 189U8 / Building Inspector '• TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: y� DATE ISSUED. X 3 46 ic SIGNATURE: Building Commissioner/I for 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 Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSEIPlAUTHORIZED AGENT ,.may M1st0rjQ QIStrict: Yes No I- 2.1 2.1 Owner of Record f •��ia //8' k n s ay cS�f l� 47dOW Name(Print) Address for SerAce: G.! L4 ?� / =� 78' 03 Signature � Telephone 2.2 Owner of Record: o � Name Print Address for Service: 0 rn Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: rvisor: n/], Y7 H Y&dWMF License Number /Vfo✓�! mn Address O / p _ q� s- Q �0/4F ExpirationDateof ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v &9 /�t/�_ lhe, /068'77 Company Name RW Q_ l /j,,l e //�,+L �� /L# Registration Number r Address O 'Mir 7 Expiration Date ^� Si natures Telephone �• 0 SECTION 4-WORKERS COMPENSATION(NLG.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.......0 SECTION 5 Descri tion of Proposed Work check altapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Ck rn 64me- 19jace., L) ka SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 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 D - 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN fgop OWNERS AGENT OR CONTRACTOR APPLIES,FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize j - to act on My be al;in 411 matt9rs relative to work authorized by this building permit application. Si ature of O�Nmer 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 Print Name Signature of Owner/A ent '- ' r Date,. , NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS . - ' ''•' HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY . IS BUILDING ON SOLID OR ILLEb LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORT#q Town of .. � � _ �� � � Andover0 . No. - _- dover, Mass., COC HICHEWICK ORATED p`P�G\ C:1 b BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • • Q.. THIS CERTIFIES THAT....... BUILDING INSPECTOR ...... �.�i►..I.�....... .. ... �.... .......................................:................ Foundation has permission to erect........................................ buildings on. 9 ..... ..�. � 0 .....� ...... Rough occupied as p 00M.40/0.00M.40/0.00M.40/0. Chimn Chimney to be occu provided that the person accepting this permit shall in every resp ec conform to he terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERM U EXPIRES IN 6 MONTHS UNLESS CONSTRU=0 TARTS ELECTRICAL INSPECTOR Rough .............. ... Oi<IL ................. Service D G INOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous -Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. U(i/3U/YUU5 THLI 8:Y6 NAX . 001/002 DATE AGORD„ CERTIFICATE OF LIABILITY INSURANCE 06/30/20 5' PRODUCER (603)669-0704 FAX (603)669-6831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Infantine Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 5125 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manchester, NH 03108 Joyce Dunlap INSURERS AFFORDING COVERAGE NAIL# INSURED.Blackdog Builders, Inc. INSURERA: Peerless Insurance 24198 7 Red Roof Lane Unit 1 INSURERS: Acadia Insurance Co. 31325 Salem, NH 03079 INSURER c: - INSURER D: . INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE'TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR 4017L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS NqRr- GENERAL LIABILITY CBP9869957 07/01/2005 .07/61/2006 EACH OCCURRENCE $ 1,000 a 00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,00( CLAIMS MADE F3�]OCCUR - MED EXP(Any one person) $ 5,00( A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ 2,000,00( POLICY PRO- JECT LOC AUTOMOBILELUIBIUTY BA9860458 07/01/2005 07/01/2006 COMBINED SINGLE LIMIT E $ X ANY AUTO ( a accident) 1,000,000 ALL OWNED AUTOS BCD LY INJURY (Per person) $ A -CHEDULED AUTOS X HIRED AUTOS BODILY INJURY - X NON-OWNED AUTOS (Peraccident) $ PROPERTY DAMAGE $ (Per accident GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN. . EA ACC S AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABlUTY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ I $ DEDUCTIBLE S RETENTION $ $ WORKERS COMPENSATIONAND WCA006920414 07/01/2005 07/01/2006 X I T1ORYTIMN GTH- EMPLOYERS'LIABILITY B ANY PROPRIETCRIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? - E.L.DISEASE-EA EMPLOYE1$ 100,000If yes.describe under SPECIAL PROVISIONS be'" E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS ILQCATI NStIVEHICL (,EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS - Various work t rougnohpolicy term. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ServEXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL Att: Insuran Inc. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Att: Insurance Dept 14203 Denver blest Parkway BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Building 64, Suite 200 OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. Golden, CO 80401 AUTHOR¢ RESENTATIV I ii ACORD 25(2009108) FAX: (866)280-9621 OACORD CORPORATION 9988 a BLACKDOG REMODELDESIGN b �T ✓1ze (� a o�✓aGaooac�ucgvh` j .00-95 000 cf;enclosed space i -BOARD.,OF BUILDING:.REGULATIONS (MGLG;'t12SsOL) License CONSTRUCTION.SUPERVIS.OR 1A Masonryonly Famlty.Homes Number CS 048847 ailure to possess a current edition of the Ci Birthdate 08L31964 Massachusetts State Building Code ! ' cause for revocation 0f'this license. I Expires 0302©07 Tr. no. 1193.0 ' i I Restrtcted 1 DAVID K BRYAN I 7 RED ROOF LN#1.._, G- SALEM, NH 03079 Commissioner DIG.SAFE CALL CENTER: (888)344-7233 I ` Board of Building Regulations and Standards License or registration valid for.individul use only: HOME IMP.,ROVEMENT CONTRACTOR tiefore;the expiration:date: If f6und°return to: Registratibn. 106877 i. Board•of Building;Regulations and Standards 7)'2812006 One Ashburton Place-Rm 1301 ' 'P'Nvate Corporation � Boston,Ma.02108' BLACKDOG BUILDSI INC, DAVID BRYAN 7 RED ROOF LN 41' GL. .�✓ Salem, NH 03079 — .. Administrator N'ot vali i. ut si&ature ti BUSINESS CONDITIONS TO THIS CONSTRUCTION CONTRACT This Contract, dated 11/14/2005 is by and between: Patricia Beckham 118 Kingston Street North Andover, MA 01845 Blackdog project code BECKH-6010-K (Hereafter referred to as OWNER), and Blackdog Builders, Inc. 7 Redroof Lane, Unit#1 Salem, NH 03079 (603) 898-0868 (Hereafter referred to as CONTRACTOR). Work will be performed at: 118 Kingston Street, North Andover, MA 01845 (Hereafter referred to as PROPERTY) 1. GENERAL This CONTRACT is for the following work and materials to be performed by the CONTRACTOR on the PROPERTY address shown above. The project is generally described as follows: Main Bath Remodel (Hereafter referred to as WORK) The CONTRACT consists of this document, any plans, the specifications, the Blackdog client package and the Construction Contract. (Hereafter collectively referred to as the"CONTRACT") 2. PRICE The total price for the WORK agreed upon is $20,060.49. Payment terms are set out below in Paragraph 6. This proposal may be withdrawn by us if not accepted within thirty(30) days. 3. STARTING AND COMPLETION PROVISIONS The WORK will begin on-approximately 1/2006 and will be completed, absent unusual or unforeseen circumstances, on 3/2006 providing this CONTRACT and any related CONTRACT documents are accepted when presented. Projects requiring two contracts (one for construction work and one for bath or kitchen product)will not be slotted into the schedule until both agreements have been executed. The aforementioned dates reflect our present workload. Projects are assigned a slot in our work schedule as they are accepted, on a first come first served basis. These dates may move based on the completion time of the project that immediately preceded yours. 4. PERMITS AND APPLICABLE CODES, COMPLIANCE WITH LOCAL LAW a. All work to be done under this CONTRACT will be in accordance with local, state and county building code. The CONTRACTOR shall obtain all necessary permits and pay all required permit and plan fees from the CONTRACT sum, unless otherwise agreed. The CONTRACT price does not include any fees, which may be incurred to obtain a variance, if required. The CONTRACT price does not include any unbid items required by any local building official to bring the project into compliance with any relevant local, state and county building code. 11/14/2005 Contract Proposal—Page 4 of 4 c. Notwithstanding any manufacturer's warranty of any component, appliance, or system, no action may be brought against the CONTRACTOR on this CONTRACT for the performance of this work, except as provided above. 14. SEVERABILITY If any portion of this agreement is found invalid or unenforceable by any court, the remaining provisions shall remain in force between the parties. 15. ENTIRE AGREEMENT This CONTRACT consists of the documents defined herein, and constitutes the entire agreement of the parties. It can be modified only by a written document. OWNER acknowledges that he has read and received a legible copy of this agreement signed by CONTRACTOR, before any work was done, and that he has read and received a legible copy of every other document that OWNER has signed during the negotiation of this Contract.. SUB ITTED: i C14 DATE : li 0 5 atricia Taylor 11/14 2005 Design Consultant Blackdog Builders, Inc. ACCEPTED: DATE: 1111YI63I Patricia Beckham DATE: 11/14/2005 Contract Proposal—Page 12 of 12 Location -A No. 1-13() Date �a_ f�3 ' U r MORT� TOWN OF NORTH ANDOVER 0 9 ' Certificate of Occupancy $ rigs',^°•Etn Building/Frame Permit Fee $ sACHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 O d Check # �� i 6 J 7 6 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 07, BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building ommissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION I 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �57' 3 6 C < ►sW� ap Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: �J Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'redProvided R 'red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomration: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑' Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record A/-'1°c i cc s La C4 he- Name(Print) Address for Service: J N-- Signature Signature Telephone 2.2 Owner of Record: vV '3 Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 6ruc e— Licensed Construction Q n Supervisor: � © 56— 0 License Number mn za,u N7-4� Expira on Date Signature Telephone r 3.2 Registered Home I�mjprovement ontractor Not Applicable ❑ _a P � 1 �v� cif C� -,�� npany Na e 1 31 D -'�3r� Registration Number r Address3 4hC J ! D Z 900' ExpiratAn Date Signature Tele hone IV 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 JEthecck all applicable) New Construction ❑ Existing Building A Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: K'"4,S_/0/1 1 hi & 0/1d r IG C e- li-J14 A hr�' 4)'rer�f- 1/7p'olanullg4' I fL ekc�rl 1(a a ayaw0_ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be a I?FIIALF'USE0NLY S (a) BuildinCompleted b g Permit Fee ermit a licant _i 1. Building � Multiplier 2 Electrical (b) Estimated Total Cost of o C7 Construction 3 Plumbing U ! Building Permit fee tel 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 OWNER AGENT OR CONTRACT APPLIES FOR BUILDING PERMIT 1, 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 Print Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2ND 3kw SPAN DIWNSIONS OF SILLS DIN ENSIONS OF POSTS DMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit 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 c 11, S 150 A. debris will be disposed The deb ose d of in:p 0�41 a (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 _ k The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 `''�� S,•'' Workers'Compensation.Insurance Affidavit Name ( Please Print Name: IC - j Location: C► 4 r Phone I am a homeowner performing all work myself. FX I am a sole proprietor and have no one worldng in any capacity I am an employer providing workers'compensation for rry employees working on this jots. Company name: Address city., Phone#- Insurance Co. Policy# Company name: Address . Insurance.Co. Policy# t=aiga a to secxse oonerage as required under seCbcm 25A of MGL 152 can lead lathe inpae. ion d pinkol P' s of a�T e o to andror one years'hnprisorirrre�nt �eeeJl as�an7 pena�es�o�elam4 ��75}P fine€(,t#f�Q rJD�a �st: understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for cowrage verification. l do ur�aler Me anaf opt Mat Y ce►�Y the 6nfarrrrlatiarr Idled P� P�� �Y Prov abowe is bye and correct Print name t0 oe Official use only do not write in this area to be completed by city or town official' DC heck l ime response is regured Libensing p Selechnan Contact person: Phone# Ej Health Del I] Other IMPROVEMENTHOME - • Design Ce n t e r ustomers Full Name Purchase Urder No.(Optional) Store No.(Optional) Service Addressor t tVt1 sJ o City State Zip Billing/Mailing Address(If Different from Service Address) IIIIIIIIIIIIIIIIIIIII111IF7-1111111 City State Zip Customer's Daytime Tel.No. Customer's Evening Tel.No. Customer's Driver's Lic.No.or State ID No. Required Attachments to this Agreement: [Installation/Fabrication Drawings* ❑Customer Service Agreement(Product and Labor Specifications)** ❑State Law Supplement*** *If applicable.**Any terms or conditions contained in attached"Customer Service Agreement"are superceded by this Home Improvement Agreement*'"Contains additional terms,conditions,and information applicable in some states.Also Includes EXPO's Contractor Licensing Nos./Bonding Information where required by law. Primary Payment Method: ❑Check/Money Order* ❑Home Depot or EXPO Card/Home Improvement Loan* ❑AMEX* []Discover* []MasterCard* ❑VISA* Primary Account Number: I I I I I I I I I I I I I I I I I I I I I I Expiration: I I I / Secondary Payment Method: ❑Home Depot or EXPO Card/Home Improvement Loan* ❑AMEX* ❑Discover* ❑MasterCard* ❑VISA* Secondary Account Number: I I I I I I I I I I I I I I I I I I I I I I Expiration: / Initial Payment: 62z a i'C-f$ L .1 Amount of Initial PaymenUDeposit limited by law in some states. Second Payment: C4 kc- $�� . (�' Applicable by law only in some states.Due approximately I 1 Third and/or Final Payment: $ Z So-& . — Applicable by law only in some states.Due only upon Installation's completion. Total Payment: $� .� Includes all applicable discounts,rebates,and taxes.Excludes finance charges. Payment schedule subject to change. You agree Your scheduled payments will be automatically charged to Your designated account(s) on or about the indicated due dates. EXPO will try to charge all scheduled payments to your Primary Account but reserves the right to charge payments to any of the accounts listed above in the order it deems necessary. You must notify EXPO no later than ten(10)days prior to the next scheduled payment date if You want to make alternate arrangements to pay. Estimated Installation Schedule Start and finish dates are approximate and may change. EXPO and Installer are not responsible for delays or Estimated Start Date: inability to complete Installation resulting from events beyond their control including, but not limited to, acts of nature, acts of governmental entities, manufacturing/delivery delays attributable to third parties, damaged merchandise, strikes or labor unrest,Your financing,incorrect information provided by You,hidden or unforeseen physical conditions Estimated Finish Date: (including, but limited to, environmental hazards such as asbestos, mold or lead paint) at Your service address, legal encumbrances on Your property,Change Orders,or Your noncompliance with this Agreement. Acceptance and Authoriza—tion: "You" means the customer identified above. "Agreement" means this EXPO Design Center Home Improvement Agreement between You and Home Depot U.S.A., Inc. ("EXPO"),which includes this page,the General Terms and Conditions appearing on the reverse of this page, Installation Drawing (not all Installations require a completed drawing) and Specifications, State Law Supplement and any other documents(as listed/checked above) attached to or otherwise made a part of this Agreement. By signing below, You authorize EXPO to arrange for an independent contractor (licensed and insured as required by EXPO and applicable law) and the contractor's employees, agents and subcontractors (collectively, "Installer") to perform the installation services ("Installation") specified in this Agreement. This Agreement supersedes all prior written or verbal representations by EXPO, Installer, or anyone else. Do not sign if blank or incomplete. If this is an in-store sale, Installer's information may need to be provided to You later. Any permit numbers may also not be available at time of sale. By signing, You acknowledge You have read, understand,and accept this A reement in its entirety.You further acknowledge receiving a complete copy.Keep it to protect Your legal rights. Acce by, Submitted by: x / &,3 C mer's ignature ate Store Associate's Full Name/ In-Home Installer Sales Representative's Full Name Associate/Represe ive:Please Print Your Name in Full and Check Applicable Box Above P ipuuI OSS - c.— 2 Installer's Full Busi ess/Trade qbme and Lic.No.(If Known/Available at Time of Sale) 7nd e Associat /In-Home Sales Representative's Full Signature Date And Lic.No.(If applicable in yo6r state)(Address available on request) Lic.No.(If applicable in your state) Additional Installer's Full Business/Trade Name and Lic.No.(If Known/Available at Time of Sale) And Lic.No.(if applicable in your state)(Address available on request) Additional Installer's Full Business/Trade Name and Lic.No.(If Known/Available at Time of Sale) And Lic.No.(If applicable in your state)(Address available on request) DISTRIBUTION: White—EXPO Copy Yellow—Customer Copy Pink—Installation Vendor Copy iznsioz IMPROVEMENTHOME - GENERAL TERMS AND r-ONDITIONS 'Scope: This Agreement is between You and EXPO. Under this Agreement, (ii)the associated finance charges(the dollar amount the loan will cost You); EXPO does not perform Installation, but arranges for Installer to do so. and (iii)the total payment (the amount You will have paid when You have EXPO does not provide, or arrange for, any architectural or engineering made all scheduled payments). You will be further subject to Your loan services or any structural changes to a dwelling. You will not pay anything to agreement's terms and conditions. Installer, although Installer may present this Agreement to You for Your Partial Payments: If this transaction will be paid by You in parts, (i)Your review and signature and/or collect payment(s) to EXPO on EXPO's behalf. payment schedule and (ii)the "Total Payment" (the amount You will have Installation is limited to,and,subject to any Change Order,will be completed paid when You have made all scheduled payments, exclusive of any finance in substantial accordance with the attached renderings (if applicable) and charges) appear on the reverse of this page. The terms and conditions of specifications. The State Law Supplement or other addenda (if any) may Your separate cardholder agreement or finance agreement will still apply if contain important additional terms, conditions, and information specific to You make any partial payments by credit card or finance any of them. Your state. Liens; Security Interests: If You make all payments as required under this Installer's Responsibilities: Installer will complete Installation in a Agreement, no lien or other security interest will be placed against Your workmanlike manner. Installer will not start, conduct, alter, or finish property by EXPO. If a security interest is placed on Your property,it creates Installation except in accordance with applicable law and codes. Installer will a lien, mortgage, or other claim against Your property to secure payment obtain any required permits and provide the permit numbers if required or if and may cause a loss of Your property if You fail to pay as requested. After otherwise requested by You. Installer may, at Your request, perform paying on any completed phase of Installation and before making any further additional work,subject to a Change Order,for an additional charge payable payments, You should receive an unconditional release from and/or waiver by You to EXPO, of any right to place any mortgage or liens against Your property signed by Your Responsibilities: You agree to pay EXPO for Installation according to Installer,applicable to the work then completed.You can consult an attorney the terms and conditions of this Agreement. If Your property is subject to any about Your rights to discharge security interests. covenants and/or other restrictions that could affect Installation, You agree LIMITED WARRANTY: EXPO WARRANTS THE WORKMANSHIP OF THE to let EXPO know about them before Installation. You agree to give Installer INSTALLATION FOR ONE YEAR FROM ITS COMPLETION DATE. EXPO access to work areas during working hours and to make drinking water and WILL REPAIR, AT NO CHARGE TO YOU, ANY DEFECTS DUE TO sanitary facilities available to Installer or pay the rental costs. You agree to FAULTY WORKMANSHIP APPEARING DURING THE ON ,f provide power to, and, as applicable, climate control in, work areas. You WARRANTY PERIOD. EXPO'S WARRANTY DOES NOT COVER DAMAGE agree not to allow unattended minors at Your service address while Installer CAUSED BY ABUSE, NEGLECT, IMPROPER USE, OR IMPROPER is present. Pets must be kept away from work areas and controlled at all CARE/CLEANING. PRODUCTS AND MATERIALS ARE COVERED times. Permits posted by Installer must be displayed at all times. You agree EXCLUSIVELY BY THE MANUFACTURER'S WARRANTY, IF ANY. EXPO not to ask Installer to perform work without a permit if one is required. You WILL ASSIST YOU WITH WARRANTY CLAIMS AGAINST agree that if You or anyone You control interferes with or delays Installation, MANUFACTURERS. THIS WARRANTY PROVIDES YOU WITH SPECIFIC You may be subject to transportation charges,storage fees or other resulting RIGHTS. YOU MAY HAVE OTHER RIGHTS UNDER THE LAW OF YOUR charges. You agree any claims against EXPO or Installer for problems or STATE OR OTHER APPLICABLE LAW. defects regarding Installation should be made to EXPO in writing within Mediation: If Your transaction is valued over$7,500.00, You agree before thirty(30) days of the date You first became aware of them. (EXPO will taking legal action to participate, if requested, in non-binding mediation attempt resolution within sixty(60)days of your notification.)You assume the (typically taking about half a day) using a professional mediation service risk and the full liability of assisting EXPO or Installer with the delivery of acceptable to You and EXPO. EXPO will pay for-the mediation service. materials or with Installation. You agree not to assign or transfer this Cancellation: YOU MAY CANCEL THIS AGREEMENT WITHOUT Agreement.Please contact EXPO if You have any claims against Installer. PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO Changes and Change Orders: Any changes to Installation, i.e., a EXPO BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING. substitution of materials or an expansion of the scope of the work will require THE STATE LAW SUPPLEMENT CONTAINS A FORM YOU MAY USE IF You, EXPO and Installer to first sign a Change Order that will become part of ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. Any this Agreement. Any Change Order must (i)clear in scope; (ii)specify any payments You made will be returned within fifteen (15) business days after additional payment(s)You will have to make; and (iii)specify any change in EXPO's receipt of Your notice.You must make available for pickup by EXPO the anticipated finish date. Previously undisclosed legal encumbrances on or Installer, at the service address indicated on the reverse of this page, and Your premises, or hidden physical conditions, including, but not limited to, in substantially the same condition as when delivered, any products or environmental hazards such as asbestos, mold, lead paint, or conditions materials delivered to You. Or You may contact EXPO for instructions differing from what You represented, will entitle EXPO to discontinue regarding return shipment at EXPO's expense. Installation without further obligation to You or ask for a Change Order. If Termination: You .may terminate this Agreement at any time for Your You decide not to make any requested changes, You or EXPO may convenience after first providing EXPO with ten(10)business days'advance terminate this Agreement as set forth below. written notice. If You breach this Agreement, EXPO may immediately Credit Card Transactions: Your separate cardholder agreement (to which terminate it without further obligation to You. In either event, You agree to EXPO is not a party) will determine the total price of Your purchase if.by pay EXPO the costs of materials, labor and services provided by EXPO and credit card, including any initial payment/deposit You may make and all Installer through the- date and time of termination, plus reasonable interest charges and fees. You will be further subject to Your cardholder administrative costs and any other amounts allowed under applicable law. agreement's terms and conditions. Returns: Special order returns are subject to a 15% restocking charge. Financed Transactions: If You are financing this transaction in whole or in Unless damaged before delivery or by Installer, custom made products and part,Your separate loan agreement(to which EXPO is not a party)will materials are non-returnable and their purchase price cannot be refunded. determine: (i)the amount financed(the amount of credit provided to You); Questions or Concerns? If this is an in-store transaction, please first EXPO Design Center Customer Care contact the store where You made Your purchase. If this is an in-home 2455 Paces Ferry RD,NW,BLDG B.5 transaction, Installer should be able to assist You. EXPO's Customer Care Atlanta,GA,30339 center also stands ready to assist You. Toll Free Telephone:1-800-380-3976 Customer's Initials: DISTRIBUTION: White—EXPO Copy Yellow—Customer Copy Pink—Installation Vendor Copy 12/16/02 r10RTly Towno-JCL 6 r4 O Andover 0 No 4 ]( 10 , dover, Mass., T IAHE COCHICHE W ICK ORATED Of C1 1 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....P.A.4-04A.14........... .�.�...�...�a.�...................................................... Foundation has permission to erect.../. ....................... buildings on ........(1.5......Kt q..%�r~.......t..�..... Rough to be Occupied as C,,�bt�..�.,LS.. I.v /�'S���/v p� Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-La relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. A 3/ c w' 3 00 avow PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS �T T T ELECTRICAL INSPECTOR V 1 V LESS CONSTR V CTION STARTS TRough . .............................................................................,,. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. N° .1 Date..SA.......................... 0 NORTH d .�ao a '��►• 3j �,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��S$�cMusf qty This certifies that has permission to perform .. ......... ...................- -. � U d.. wiring in the building of.:.. ..:�� ........ ........................................... at./ .... ....... ....... ,North Andover,Mass. Fee .............. Lic No.AZP.P?-......................................................... ELECMICAL INsnc-rOR 02/23/98 16:13 ID C � WHITE:Applicant CANARY: Building Dept50,04 � . INK:T r 4k I/-- \ Office Use 0 �,r � >r C�IITIZmIIItUJEIf IIftt �tt>rl�u�ett Permit No. _ i9ep irtinent of Public i�§AfttE Occupancy& Fee Checkedv�� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 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 #LL INFORMATION) Date ?—,IS-19:5 City or Town of) • -����-��f P ➢2-- To the Inspector of Wires: The udersigned applies fora permerform the electrical work described below. n Location (Street & Number) it to 1,km (:; E V,3 �t e' Ova S . Owner or Tenant t `�rj} 1� Owner's Address u t N SV v ` C N10-1) Is this permit'-in conjunction with 4 building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building , Utility Authorization No. Existing Service'-70 Amps �a Volts Overhead a Undgrnd ❑ No. of Meters New Service 22�— Amps/_2_1_9J Volts Overhead ® Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work otal No. of Lighting Outlets No. of Hot Tubs No. of Transformers TKVA No. of Lighting Fixtures Swimming Pool Above In- No. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers 1 Heating Devices. KW LocalMunicipal ❑Other ❑ Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP T_ OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES �{1{ NO I have submitted valid proof of same to the Office. YES R NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE fid BOND ❑ OTHER (Please Specify)_ (Expiration Date) S Estimated Value of Electrical Work $ ` M fD Work to Start 2---1 –CI — Inspection Date Requested: Rough Final ® hh a`dao y� Signed under the Penalties of perjury: 01M bk �IF FIRM NAME F3arker ElectricLIC. NO. A 1 S3 9 2' Licensee David Barker Signature LIC. NO. P241 5:— Bus. Tel. No. 7( �1 — Address 50 Lakeshore Road, Boxford, MA 01 921 Alt. Tel. No. ( 9 /O1 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) _•____ Telephone No. _ ..._ PERMIT FEE $ (Signature of Owner or Agent) x•o5o5 Date.................................. NORT#1 °`t"'°�•_�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 'TS US This certifies that ......s .�.(.1.� .....e.. �.�. .....................................:.. has permission to perform ...... -�........ .�'.` .................................. wiring in the building of..... . c j4 `�` ................................................................ l / B <t"' S 4 Q S �............. .North Andover,Mass. at............................. ....:�.......................... .. t� r Fee..... ............ Lic.No-?. .' ? 1..4...... ELECTRICAL INSPECTOR Check # � Official Use c �r7 Permit No. tQe 101 Oap✓ancy&Fee Chec BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR Pi..RMI TO PERFORM ELECTRICAL WORK I� All work to be performed in acc dance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number K h i * 5- Owner Owner or Tenant �ig (J`e L ho nn Owner's Address J b Is this permit in conjunction with a building permit Yes No 0 (Check Appropriate Box) Purpose of Building Co Utility Authorization No. Existing Service Dy Amps /20 /ZW0 Voits Overhead 0 Undgrnd® No.of Mete New Service Amps Voits Overhead 0 Undgmd 0 No.of Mete Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work e vH a el Y( t `Nty rti [ fytcx. VSP r2 X1 4- 01 1< Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above a In a No.of Lighting Fixtures Swimming Pool gmd a gmd,9 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Bumers Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone _ Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices _ Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices _ NoJ of Self Contained No.of Dishwashers t' Space/Area Heating KW Detection/Sounding Devices _ n Municipal a Other No.of Dryers Heating.Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid 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) 0 / —6,/ / Estimated Value of.Electrical Work$ / S b U (Expiration Date) Work to Start Inspection Date Resquested Rough Final Signed under the Penatties of perjury:,_• FIRM NAME /f A t / / t r G LIC.NO. 43 Licensee 6 le t/c t ry C 4f2 Signature LIC.NO. I/ /t Bus.Tel No. / 7 Y 7 ra C 0 �o lj Address )^G c qje 4ZC A.'2_ U. Alt Tel.No. Z OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as rTE�$ 3 General Laws.And that m signature on this permit application waives this r uirement. Owner Y g P PP eq Agent (Please Check one) Telephone No. PER (Signature of Owner or Agent) _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 9wF Boston, Mass. .02111 Q Workers'Compensation,Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers'compensation for my employees wnrtdng on this jot Company name: Address City Pfe Insurance Co. Policy#. Company name. Ad+iiress. . Insurance.-Co. Poli # Fa kwe to secure coverage as required:under Section 25A of K4GL 152 cartk Wthe dma cxirriilw or ar5t ancllorom years'imprisonrnent-as_yagl-as_cnQ imnatiesm-thelacm-cita fiaei#(S7A�ElOt}at y ir>de►stand that a copy of this statement may belorwarded to the Office of Nvesfigabons of the DIA for coveiraga verifi ,,h . Ido here y c"tfy under Bre pains annd penalties ofpefjLwyhW Mex rmahm provided above is true and caornect Signature DOW- Print iePrint name official use only do not write in this area to be completed by city or tmn offidar City of Towrn Prxl. El Bate, �Chedr Y immediate response is required -0 Lia Q Se! Contact person: Phone# He 0# r Date. TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING '�SSACNUS� // This certifies that . . . . p��. .L . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . .�.f. l. . . . �. plumbin i the build'ngs of . l at .. .� L .,.�.J� � ��!:: .: . . . . . . . . . . . . North Andover, Mass. 4<r . Fee.�/.�F . �Lic. No. r. . . . . . . . . . . . . . . . . . . . . . . . . . . . / PLUMBING INSPECTOR Check 9 /�7` MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS � t Date IAO 4Building Location 1 Owners Name t Permit# Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES z -et cr o wc w a x a � F F Ca A F va SLFIFS IC RAg1UM M FIDOR 21\II FIpOR 3MFLOCR 4M HDM sm FIDOR 6M HDM 7M FIDOR gIII HD R (Print or type) Check one: Certificate Installing Company NameElCorp. Address �' � � I,x h IV"c itc e�1 I' r O 1 kr)�7 ❑ Partner. Business Telephone Ci sk - 911 L, El Firm/Co. Name of Licensed Plumber: 7-3� C1.v4-Q 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 installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts e Plumbing Cod and Chapter 142 of the General Laws. BY igna icense PlumDer ype of Plumbing License Title City/Town icenL se Num er Master13Journeyman APPROVED(OFFICE USE ONLY a�