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Miscellaneous - Exception (756)
Date ....:17... � ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING kleoll. IK -11- C Zlf I , Thiscertifies that ........................................................................................................ ........... has permission to perform ............................................. / ..................................... ,,,einnl,, in the building of ....... ...... .....6 a ............... / ........................................................................... 6- 4� �- North Andover, Mass. at IN", 64)A'- '--y ........ ...... - ................................................................................. Fee......~... ...................... Lic. No. ....... ........................ . . . . . .. .............. ... ............ i��RliC&AL INSPECTO Check # Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official lUse Only Permit No. Occupancy and Fee Checked [Rev. 1/07) (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perf rm the electrical work described below. Location (Street & Number) (-2_l A/2 rA6 Owner or Tenant Telephone No. Owner's Address�� kPi� Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building J j! (" 3E:L Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Completion ofthe following tahle may he waived by tha Tn.cnectnr of Wires. No. of Recessed Luminaires _. No. of Ceil: Susp. (Paddle) Fans V No. of Total Transformers KVA No. of Luminaire OutletsNo. of Hot Tubs Generators? No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets 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. Total Tons No. of Alerting Devices g No. of Waste Disposers 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: Attach additional detail if desired, or as required by the Inspector of Mres. Estimated Value of Electrical Work Z. Z}V • � (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. UR CHECK ONE: INSANCE [IBOND [IOTHER ❑ (Specify:) I certify, under the pains and penalties of er'ury, that the infor at' n on this application is true and complete. FIRM NAME: _ n , LIC. NO.: Licensee: Signature`,LTC. NO.: (If applicable, ent "exe " in the license number line.) Bus. Tel. No. Address: oc U ER1OG Alt. Tel. No.: *Per M.G.L c. -7, s. 7-61, security work requires Department of Public Safety "S" License: Lic. No. � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement: I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent p EERMIT FEE. $ Signature Tele hone No. ❑ 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 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, fine 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 M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ In Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors C mments: Inspectors Signature: ,,,,�.�� Dater G f/ • / Sr ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTI Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: &V?4 ,;Vw- D� - 3. - Inspectors Signature: Date: DEB WE.INHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 < Boston, MA 02114-2017 " www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �a City/State/Zip: 1J(V Are you an employer? Check the appropriate box: Phone #: P%I - (0- %e LF -1 I ammaa employer with employees (full and/or part-time).* 2. a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.# 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. [ I11 modeling 9. ❑ Demolition 10 0 Building addition 11.F1 Electrical repairs or additions 12.E] Plumbing repairs or additions 13.0 Roof repairs 14.E] Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C2e OSS ;E1_�� Policy # or Self -ins. Lic. #:_4!22�4 j'�170/61!Z Expiration Date: Job Site Address: C- l (L 0/0 City/State/Zip: &,,rA,�/",>2 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c96ify under the pains and penalties of that the information provided above is true and correct. 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 #: 4k - 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 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-contractor(s) 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. A new 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia r • Location [ �rT No. Check #i9j_1 25148 Dat v'/ TOWN OF NORTH ANDOVER Certificate of Occupancy $t Building/Frame Permit Fee $ Foundation Permit Fee $. Other Permit Fee $ TOTAL $ Building Inspector goRry 1 �_. 'Town of North Andover Machuie Shop Village Neighborhood Conservation District Commission 1600 Osgood Street North Azidover MA 01845 SACHUSE Application For EXCLUSION From Certificate to Atter For Items 9, 10 or 11, provide the following documentation- •'r Photos/drawings of existing doors, windows or siding, as applicable Description/Catalog Cuts of proposed materials to be used for doors, windows or siding _Flan and elevation of reconstruction forItem 11 Determination: This project is determined to be exempt C] 1 t exempt fi-om review by the Machine Shop pillage Neighborhood Conservation District Commission. Projects that are not exempt must complete the Application for Certificate to .Atter, available frons the Building Department and be reviewed by the Commission. all, E Neighborhood Conservation. District Comnission. 11,3112 - Date MSV NOC Page 2 Current Chair Liz Fennessy, 77 Elm Street, lirettafennessy@vahoo com, 978-088-2915 I CL 4- CC to 0 00 a. 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Vol 0 m U M LU i< ° W W n °/ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 11%2o www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ODlicant Information pinoon v..:„+ r __:1.h Nalne (Business/Organization/Individual): Address: City/State/Zip: Phone #: _��7^ 134 n employer? Check the appropriate box: AiM 1. a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ['Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is pi information. Insurance Company Name: workers' compensation °e for my employees. Belo 14-', A vfo(�, the policy and job site Policy # or Self -ins. Lic. #: Expiration Date: '" 1 Job Site Address:_ 2.3 l_ Ct cc/�J, , G Ai City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c ie pa' and of perjury that the information provided above is true and correct. Sign re: Date: G/ 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. F. Watson General Contracting 3 Edgemont Street Derry, NH 03038 Tel. 603-437-6134 Cell # 603-661-5360 NAME/ADDRESS Mike Dambach 27 Clarendon Street North Andover, MA 01845 Estimate DATE ESTIMATE # 11/18/2011 1481 OWNERS SIGNATURE Page 1 TERMS PROJECT Due on receipt Deck ITEM DESCRIPTION QTY COST TOTAL labor Carpenter's labor 80 42.00 3,360.00 I.Install temporary support of roof. 2. Dismantle and dispose of existing deck and railings. 3. Dig and install 12"X48" sono tubes filled with concrete. 4. Reframe deck, stairs, railings, and roof support post. 5. Install lathes panels around bottom with access door at end. Sono Tube 12" Sono tube T long 4 9.95 39.80 Concrete Mix Concrete Mix 601b. bag 16 3.99 63.84 Anchors 6"x 6" Post Anchor 4 16.79 67.16 PT Wood 6"x 6" x 8'-0" P T Wood 2 17.54 35.08 2x6xl6'PT 2"x 6"x 16-0" P T 2 11.82 23.64 2x8xl6pt 2" x 8" x 16'-0"PT 6 14.84 89.04 2x6x12PT 2"x 6"x 12'-0" PT Wood 12 8.83 105.96 PT Wood 6"x 6" x10'-0" Pressure Treated Wood 4 25.16 100.64 2x4x16PT 2"x 4"x 16'-0" Pressure Treated 10 6.91 69.10 2x2x42PT 2"x 2"x 42" PT Wood Balusters 140 1.19 166.60 2x12xl2pt 2"x 12"x 12'- 0" Treated Wood 3 15.69 47.07 5/4 x 6 x 16 5/4 x 6 x 16 PT wood 28 10.02 280.56 5/4x6x12PT 5/4"x 6"x 12'-0" PT Wood 5 7.02 35.10 4x4PT 4" x 4" x 8'-0" Pressure Treated Wood 1 8.44 8.44 Lathes 4'x 8' Heavy duty privacy lathes Treated 4 32.52 130.08 Pine 1"x 6"x 16-0" Primed pine 5 14.68 73.40 Miscellaneous Miscellaneous 180.00 180.00 Dumping Charg Disposal Fee Allowance 180.00 180.00 Cont. fee Subtotal labor & Materials Contractors 10% Fee profit + overhead 10.00% 5,055.51 505.55 THANK - YOU A. F. WATSON TOTAL OWNERS SIGNATURE Page 1 A. F. Watson General Contracting 3 Edgemont Street Derry, NH 03038 Tel. 603-437-6134 Cell # 603-661-5360 NAME/ADDRESS Mike Dambach 27 Clarendon Street North Andover, MA 01845 Estimate DATE ESTIMATE # 11/18/2011 1481 OWNERS SIGNATURE Page 2 rd M if NoArj/ E� M1030 -A laws -11,041-4 TERMS PROJECT Due on receipt Deck ITEM DESCRIPTION QTY COST TOTAL Permit Town of N. Andover building permit fee 85.00 85.00 THANK - YOU A. F. WATSON TOTAL $5,646.06 OWNERS SIGNATURE Page 2 rd M if NoArj/ E� M1030 -A laws -11,041-4 Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the states Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of "A Massachusetts Consumer Guide to Home Improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name ^C ` Comp Nart�e �� 1 ,,_, ce Street Address (do not use a Post O io dress) Contractor/1/Sala. person/ 0,er N� dON S i eeT u(� Vl/ SOE 4aru City/Town State AIAAJOV&(, N Zip Code ON5, Business AddrFss (must include a street address) _?k4jiCM&NT aytime Phone Evening Phone Cityn own St to Zip Code Mailing Address (It different from above) Business Pho d Federal Employer ID or S.S. Number law requires that most home um fid ntmmi munb hcvc valid nghhatloa number Home rngaoveman Commetm Reg. Nmnb><r Expirmion date 7013 The Contractor agrees to do the following work for the Homeowner. (Describe in detail he work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necess .) pefY>o/©�S�r�an�� cQec�C o,�d -����.-�c�.r►�in� Qe c�rw�, -�'�eofz-j.�/ k�,�i1Y Rl;�u\v J qj- Q,s QraUjvjL UJ c`�% Aae-56 doge- ON Required Permits -The following building permits are required Proposed Start and Completion Schedule -The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) *_Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule �,y+� A� The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: !N• W (') Payments will be made according to the following schedule: $ upon signing contract (not to exceed 1/3 of the total contract price /oar the cost of 'al order items, whichever is greater) $-%'- by �! t %/ /2or upon completion of � ��/��/G!/J �T% / C7✓ $� by / / or upon completion of $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both patty's satisfaction) The following material/equipment must be special $ p d for ordered before the contracted work begins in order to meet the completion schedule.(••) $ for NOTES: (*) Including all finance charges (f#) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty -Is an express warranty being Provided by the contractor? No ❑ Yes fall terms of the warranty must be attached to the contract) Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE Two identical copies of The contract must be completed and signed. One copy should go to if Homeowner's Signature Date Date Massachusetts Home Improvement Sample Contract Tbhs farm sathstres all basic regnirentertts of the stere s Home tmprovernmt cenataemr Law (MGL chapter 142A), nut does not htrctode standard tangaage to prated homeawuera. Seek legal ad— if necessary. Any person Prang home improvmmeuts dmxdd first obtain a aW of "A Massac:hasM Consumer Guide to Nome Improvement" before agreeing to any work on your rmdenm You may obtain a flee copy by calling the Office of Consumer Affkm and Business Regular's Consumer Information Hodma at 617-973.8'87 or 1-g88-283-3757 or on oto website. homeowner tntormatton Contractor Information Xe-, e t 4w t LSA Sheet Address (do not use a Pon a ) d©�v 5 Qeefi Contractor/ Sidespersout OVOr NAMV v(z, Wsart/ Gty Sate Tap (ode Business_w (must mclnr asrnir�`„� Vvt O eJ' e'Ai Pluete Ci p A t' ;;sailing Address (It ihM"m fico aurone) Basinew M.M4 jh—daWFA;p1yjer ID or S.S. Number aateuw dew •.t9a rr;sa.w.�6rb— R�te�O:emn+csge.t+®e.E±yerimdem i y�` Q 'i — zs— a,oi3 The Contractor agtets to do the following work for the Homeowner: Quibe in detail the wont to complebul, specifying de typed brand, and grade of material, to be usod, owaddtuoml Aso ifac I (+-(-k and Re r�r�e,���z,.,u�� nlred Permits -'Cite following building permits am nmWued will be segued by the couttaaor as the homeowner's agent: wners who secure their own permits will be Jaded from the Guaranty Fund provisions of X chapter 142A.) Proposed Start and Completion Schedule -The following schoduk will be adheredto unless cumu rnstarim beymd the coubactofs cosuol arise whet contractor will begin contractod work whoa contracted work will be substmaeany completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work, finish the material and labor specified above for the total sum of Payments will be made according to the following schedule: S0. upon c&niaQg contraacct (not to exceed lf3 of the total contract price q �t'hhe cost of order items, whi knw is Wester) S_11,16L /��L brJ f ,�` �or upon cortlost of c Ll- rY /J fK { ;R , by 1 I or upon completion of S 1`/ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both parry's satisfaction) 71te foltawks matefawlerpupmeat must be W.C.1 S 'd for wderd before the coamt d wok berms err order to med the ccrroad n schedde.(s") $ for NOTES: (•) Including all finance oharan (•') Law requires that any deposit or down -payment required by the cormwwr before work begin may not emceed the greater of (a) onodgtd of the teal comrad price or (b) the aemet cast of Ray special equipment or astom made material which must be spouse! ordered in advance to meet the comptam schedak. Eaturms R'amnb- h sa ezmrs, wtrr�.ty brine marbled ler the coeU'ader? Na ©Yea (all !vita of e� warrarrir mv:tr be siise� to ebr cow n Subcoubacters - The contractor agrees to be solely respomnMe far completion of the work descrtlied regardless of du: actions of any third pmVsuboontractor tnilcied by the contractor. The contractor fart#a r agrees to be solely tespomble for all payments to all suboomractors for materials and bbcw under this MMM Contract Acceptance- Upon signing, this document beoomes abindws contract wxW law. Unless otherwise noted within this dammnent, the contrad "not4rtrplythataaplien�orother seaniryt hebow placed onthetesidattee: Reviaw&tefoHtrwing�tti<tnsaedaatioea corefhIiy heft ahgniog this aouttat. • Doa*tbe pressured into signing She contract. Take time to read and fully uodcrat n it Ads gttestions if somedung is unclear. • hlakt: sure the contractor Inas a valid Hove lmutovemem Coatracmr Ra pion TTu law regwm most hoar m4wovemmt ctrl and subcontractors to be registered with the Director of Horne bq mvemart Contractor Registration. You clay mquine about contractor re&ration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 61.7-973-9787 or 8$&283-3757. • Does the Contractor have insmaoce? Ask the Cir for his utsmmuee comparry m&rmahoa so drat you can confirm cuverjge, or ask to sere a copy of a goof of insurance document. • Know para rights and responsibilities. Read dee Important Information on the reverse side of this farm and get a copy of the C asumer Guide to the Rome Improvement Contra= l.aw. You may cward this agreement if it has been signed at a place other than the ods normal plat Cfbusatess, provided you norify the contractor m writing at hm&er renin office or branch office by ordinary matil posted, by telegram sort or by delivery, not later than mmol & ofthe third bxrsa= day following the siguiegof this agrees, See the wed notice of caoccoarion form loran eaolacaftua ofthis naht- DO OT SIGN THIS CONTRACT IF THERE capiwo(deeeaaftamaabead tiptoed Our capy dvAd 0 e, r} Homeowner's Signature Cc 13ate Date IRIZ 61 A. F. Watson General Contracting 3 Edgemont Street Derry, NH 03438 Tel. 603-437-6134 Cell # 603-662-5360 NAMEIADDRESS Mike Dambac h 27 Clarendon Street North Andover, MA 01845 Estimate DATE ESTIMATE # 11/18/2011 1481 t r ... OWNERS SIGNATURE Page 1 U . 1, .. F/P TERMS PROJECT Due on receipt Deck ITEM DESCRIPTION QTY COST TOTAL labor Carpenter's labor 80 42.00 3,360.00 1.Install temporary support of roof. 2. Dismande and dispose of existing deck and railings. 3. Dig and install 12"X48" sono tubes filled with concrete. 4. Reframe dcck, stairs, railings, and roof support post. S. Install lathes panels around bottom with access door at end. Sono Tube 12" Sano tube 4' long 4 9.95 39.80 Concrete Mix Concrete Mix 601b. bag 16 3.99 63.84 Anchors 6"x 6" Post Anchor 4 16.79 67.16 PT Wood 6"x 6" x 8'-0" P T Wood 2 17.54 35.08 2x6xi6PT 2"x 6"x 16'-0" P T 2 11.82 23.64 2x8xl6pt 2" x 8" x 16-0"PT 6 14.84 89.04 2x6x12PT 2"x 6"x 12'-0" PT Wood I2 8.83 105.96 PT Wood 6"x 6" x10'-0" Pressure Treated Wood 4 25.16 100.64 2x4xl6PT 2"x 4"x 16-0" Pressure Treated 10 6.91 69.10 2x2x42PT 2"x 2"x 42" PT Wood 13atusters 140 1.19 166.60 2xl2xl2pt 2"x 12"x IT- 0" Treated Wood 3 I5.69 47.07 5/4 x 6 x 16 5/4 x 6 x 16 PT wood 28 10.02 280.56 5/4x6x22PT 514"x 6"x I2'-0" PT Wood _...... _._.n.......... 5 7.02 35,.10_. 4A4P1' 4 x 4 x 8'-0 Pressure'Ttea#ed Wood I 5.44 . _ . 8.44 Lathes 41x 8' Heavy duty privacy lathes Treated 4 3252 130.08 Pine IN 6"x 16-0" Primed pine 5 14.68 73.40 Miscellaneous Miscellaneous 180.00 180.00 Dumping Charg Disposal Fee Allowance 180.00 180.00 Subtotal labor & Materials 5,055.51 Cont fee Contractors 10% Fee profit + overhead 10.000/0 505.55 THANK - YOU A. F. WATSON TOTAL t r ... OWNERS SIGNATURE Page 1 U . 1, .. F/P A. F. 'W"atson General Contracting 3 Edgemont Street Derry, NH 03038 Tel. 603-437-6134 Cell # 603-661-5360 I NAMEIADDRESS I Mike Dambach 27 Clarendon Street North Andover, MA 01845 Estimate DATE ESTIMATE # 1IIIIV2011 1481 OWMMS SIGNATURE f - Page 2 r TERMS PROJECT Due on receipt Deck ITEM DESCRIPTION QTY COST TOTAL Permit Town of N. Andover building permit fee 85.00 85.00 THANK - YOU A. F. WATSON TOTAL S5,646.0306 OWMMS SIGNATURE f - Page 2 r k• . jp r i 4y •��'r�" �f. a.;f a;f.,1{� j }ir #SY ,'"�S yt 1�'#� -n a} q l try }� { • s 1 � s t F � � >k # 4�#fit' t tk +1s° iEt 1 f � � f E ` k r t t r { � : "4 :Tfri' �T�1 Al � ' •'u°'r'y� ;F���F �Frj31 �r�iYr� {tl , i ! � � • z � � t { y � 2 � - ;:.'�:�.. ,. �� ,'A t t An - DID iP t i f aa� a d' - N X N I P f� a d' - N X N I fDate .%'...�°... .... . f ,,ORT#1 pya a.ao ,e 1tipL TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that ..! �?-.'•!.. :' ........... has permission for gas installation`!. .. ............ in the buildings of .� ...................... at. - ....(.:............... -x,!%. , North Andover, Mass. Fee' ..... Lic. No.���,, ........... GAS INS00OR Check # AISSi4CHType)- ._UlV1FOf 1 tArint or Type)- Ap ATIO*-S��T-TO D0'(3ASFrMNG.. ►��vEO� massw Date l O -L � . P, eo,x,—a 7 C ru -Pwnees h j r CM r �s( T rte of New ❑ Rte_ Ra Plant SubmNec Y Nob_ :a .sx-III&WONO m�� iNSURANCE-.COVEM s ; t have a Yes potigflt..e�hwt>fchi-rneets.#he'requtrents-of. n ve you heqtOvW a: )IQcL Cts _142. ` m*WkxWheIYPe—a ge by, the 2PPwpdate.. A liabitty kUu anoe wh y Ou"r.bA e' LMdemNty. Q - 8ond Cl gWNER•S INSURA<4CE WAS. t anr Iwan3 Chapter 142O( -the- fJ :theilcensee-dpa,A-tm Mass' Generd=Lawa. -and w -the VW—.My signature °on.this Permit a revenge requkedby. _ this regt*ement. gnat oi�Owaaar Check one: -,oF-Owi�ears Amt:.. ow�ter❑ A� :0 . thereby Cerw thata8 of the deta�s and.in ==tion thane subnuttad (� 0 9a aW Mat a�. wdemW in above ' pelt provisions �. w+otlratb insta�afions p�� tubae the petmif.iss � anew toahe best.oi my- tusetts State Gas Code orad chapw. IQ of the Geraeratin arca wiffr air By - Tette - T of LxxnsC nahua _ Gasfitter a Y/%wn Master Anan man ME Ila so so MITI :a .sx-III&WONO m�� iNSURANCE-.COVEM s ; t have a Yes potigflt..e�hwt>fchi-rneets.#he'requtrents-of. n ve you heqtOvW a: )IQcL Cts _142. ` m*WkxWheIYPe—a ge by, the 2PPwpdate.. A liabitty kUu anoe wh y Ou"r.bA e' LMdemNty. Q - 8ond Cl gWNER•S INSURA<4CE WAS. t anr Iwan3 Chapter 142O( -the- fJ :theilcensee-dpa,A-tm Mass' Generd=Lawa. -and w -the VW—.My signature °on.this Permit a revenge requkedby. _ this regt*ement. gnat oi�Owaaar Check one: -,oF-Owi�ears Amt:.. ow�ter❑ A� :0 . thereby Cerw thata8 of the deta�s and.in ==tion thane subnuttad (� 0 9a aW Mat a�. wdemW in above ' pelt provisions �. w+otlratb insta�afions p�� tubae the petmif.iss � anew toahe best.oi my- tusetts State Gas Code orad chapw. IQ of the Geraeratin arca wiffr air By - Tette - T of LxxnsC nahua _ Gasfitter a Y/%wn Master Anan el 41 a J d at < W M. ad < < <4d AL W Y ' MCI _ °: IL Date. TOWNd OF NORTH ANDOVER a a a ,PERMIT FOR GAS INSTALLATION This certifies that .. .. .......... has permission for gas installation`'-*� ......... . in the buildings,, of7�-r :..� r!�'`..."'...`..�'............... . at . — 1,.,..4--�c:-r .�.. , North Andover, Mass. Feed ..... Lic. No...�.y>�!......... . GAS INSEfZT.R Check # J& (� 5256 MASSACHUSETTS UNIFORM APPLICATION FOR PERfYftT TO DO PLUMBING ;Pint of Typed Lor+G� ,gyp— mas& Da. /� b. Pon* -SP 9 BuWft Lomti.. C 1 oung n d©yt, - p ,s Name r '� Type of 0c"Wncy New p Reny p Repiac t 9cFIXTURES P� Submitted Yes o No G BASVAgNT 15T FLOOF 2ND FLOOR 3RD FLOOR 4TH FLOOR 51H FLOOR 6M FLOOR 7TH FLOOR " tTfFt FLOOR Ades_ L:i14 Check Otte: 0 Corporatiofi 0 Pwuwwlip FWMCO, DOORANCE.COVERAM - - Iham AMM" Y Dolma► or its Yes)K ft D mobil equnralem which meets atMGLMGL CIL 142. ff you thane yew please irk by,.appropriae boaL Ar�'�y� pO- ' Other type Of atm, D OWNWS VRAMCE WANE tam - saw des tt2 of it*Mas&C aware that the r does not nage the Laws~ and�► s e Cn this PwM e of ow,Kr or OarneYs Ap> Cheek ons Owna ihat as o� tfleee&w d ; pn iham y Agem . D - bti6 WW kCl9eaW asst att X19 watt to altea ;a �„r ion ar(a trade and accuaft tp porisio.as of »aeAft=aa%mft ""°a puma :issued foruft a0poca*n wa * . a!�� � ttae Cxnaat tsars. soma ft of t;eeraoen pkwd w T"e of maseT;x L1MM fiber W S W Q sa iL NC N z3za. a =CID af �5E+� ¢.a ¢Oju, = U C < 1u co W Ri to .3 <3wmS. > U w = �.. W Y Z J < co Q0 U 1]D Go i o~ ¢ m < W co Y< 1tf W IX I Check Otte: 0 Corporatiofi 0 Pwuwwlip FWMCO, DOORANCE.COVERAM - - Iham AMM" Y Dolma► or its Yes)K ft D mobil equnralem which meets atMGLMGL CIL 142. ff you thane yew please irk by,.appropriae boaL Ar�'�y� pO- ' Other type Of atm, D OWNWS VRAMCE WANE tam - saw des tt2 of it*Mas&C aware that the r does not nage the Laws~ and�► s e Cn this PwM e of ow,Kr or OarneYs Ap> Cheek ons Owna ihat as o� tfleee&w d ; pn iham y Agem . D - bti6 WW kCl9eaW asst att X19 watt to altea ;a �„r ion ar(a trade and accuaft tp porisio.as of »aeAft=aa%mft ""°a puma :issued foruft a0poca*n wa * . a!�� � ttae Cxnaat tsars. soma ft of t;eeraoen pkwd w T"e of maseT;x L1MM fiber W S W Q sa iL NC N z3za. a �5E+� ¢.a ¢Oju, C < 1u 0 Y W Ri to .3 <3wmS. Check Otte: 0 Corporatiofi 0 Pwuwwlip FWMCO, DOORANCE.COVERAM - - Iham AMM" Y Dolma► or its Yes)K ft D mobil equnralem which meets atMGLMGL CIL 142. ff you thane yew please irk by,.appropriae boaL Ar�'�y� pO- ' Other type Of atm, D OWNWS VRAMCE WANE tam - saw des tt2 of it*Mas&C aware that the r does not nage the Laws~ and�► s e Cn this PwM e of ow,Kr or OarneYs Ap> Cheek ons Owna ihat as o� tfleee&w d ; pn iham y Agem . D - bti6 WW kCl9eaW asst att X19 watt to altea ;a �„r ion ar(a trade and accuaft tp porisio.as of »aeAft=aa%mft ""°a puma :issued foruft a0poca*n wa * . a!�� � ttae Cxnaat tsars. soma ft of t;eeraoen pkwd w T"e of maseT;x L1MM fiber t Y w - 110 s act• 06.: 2 a _ (MSI IL O � W m' K Q t Y w - 110 .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... ......... .............................. has permission to perform ........... . ...... ........................... ........ ... ................. wiring in the building of ......6-:'n �' ......................................... /1P V at ..... ..... 41�..'4.-.�-77� �.'4e7 ....... North Andover, Mass. ... . ..... .. 1-6 A Fee ..�,� .............. Lic. NoA .......... ............... ELEcTRICAL INSPECTOR Check # 4:47 TBECOMMONWEALMOF. DEPARTAIEA 'OF. BOAROOF APPLICATIONFOR PERMIT' ALL WORK TO BE PERFORMED IN ACCORDANCE WITH (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover TTS Office Use only Permit No. 47417 CMRI2:00 -7- Occupancy & Fees Checked �� RMELECTRICAL WORK ELECTRICAL CODE, 527 CMR 12:00 Date /"q —1�;- di; The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) r/�%C -E'�`'t,�/' 0, Owner or Tenant /-S /� j' a C A �V Owner's Address , 5) % r/ O AV S T— Is this permit in conjunction with a building permit: Yes M No r7 To the Inspector of Wires: (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service AmpsVolts Overhead Underground No. of Meters New Service Amps olts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above M Below Generators KVA r ground rJ No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- htsuranoeCDWr,V, Rua>antto&04Z r]aliSofMassacta>se CfnaalLaws IbaNcaamaltIiatn7Rykmm=RblicyitdxkgCofTide Cover,Werit,mbSU"ffova]art . . YES NO IbavemhT WdvaWptoofofsametotbeOffioe, YES17/�ff}aubavedrdodYES plea9e"U-adletypeofcc)wrageby drddngtbe alebox INSURANCE BOND a MER o ftweSpa*) w«k!Dsratt .�o-�3 �a �- swedunderManatiesofpajtuy.. FIRMNAMEi'�/�/���5 r4wdacnime Esttnamd ValueofE1o=cal Waic $ Rough Final LioawNo. _ 7 Liar�eNo �f ---b Id.No. 94L:P- ez5 /St>F, Adrlrecc_G S % -CT 6g,116,Z 1 A]tTel.No. OWNER'SINSURANCEWANFR;Iamawated a &Lmmdoesnothavetheirmuaiicecore ageoritsmbstnxialegtrivalata ]t tti led ,iMassacltus l(:C naa 'm — anddratmysig�atmonfispa=apphcaatimwaivesthiste4mi enlent (Please check one) Owner Agent Telephone No. PERMIT FEE $ Signature o caner or gen The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 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 I am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address city Phone #: T Insurance. Co. Policv # Company name: Address City: Phone #: Insurance Co. _ __ _ _Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,50().00 and/or one years' imprisorxnent_as_wetl_as_civil.penaltiesinlheionn-daST_OPMAM ORDER.and_afore-f_($1110.DD)arlayagainsi.me, I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. y l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Pbone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/licensing. 0 Building Dept I]Check if immediate response is required 0 Licensing Board p Selectman's Office Contact person. Phone #. I] Health Department - -- - - Ei Other Claim # 2523877 Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings Town Hall North Andover, MA 01845 Re: Insured: Scott Leblanc Property address: 32 Clarendon St. #2 North Andover, MA 01845 Policy #: 2523877 Loss of: 2011/10/30 File or Claim No. AD 9622 Board of Health CV11, Board of Selectmen Town Hall North Andover, MA 01845 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,_Ch._139_Sec. _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 or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated above by fir t class mail. 1-2-11 S gnature and date