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HomeMy WebLinkAboutBuilding Permit # 4/5/2016 NORTH ILDING PERMIT o��t�Eo 06" TOWN OF NORTH ANDOVER ® APPLICATION FOR PLAN EXAMINATION ' m �� Permit No#° Date Received 7RD°HATED Ry �SSgcHus�`� Date Issued: 41MO—RTANT:Applicant must complete all items on this page egg .�' r` �' .., m .%r v✓'r , r,d ,:.. a :..,.,,,. �/` rr y,. � rr,. .k� ,�,. ,_ ,y � x � f �✓P� rr/r xr rel �. .,r lx r<,.,,.r�'✓ ..,.. ,- c ","r ,�- mr r` .!./ ?�� ff r a .'' �'� ,a9/,"i ,f y.._:.. , .. € ✓ ��� s r„.,. 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X- ,-i`'.� v r1c,1.,;�r .F :�l a:L ,a/!,fj 3 rte! ✓7v r r r�1flf".'< ..,�i �,<, x,� .sm r�.r `'�` 1r.3,'e^� �. �" f� r t ,��51 t�� .;:�pier��, a c,"�f/ r.,.✓.urr.'./r<P s l„ 3'... �,% �,r. / / J,�,h mL'� /f�Y�a'f .o, ��,' i' �,�s�^� '.err73,'' 1�". � � r ,. +°:rk -., �s:.:z.rr �..C. .. ✓f it r � r.r�/f.tr r�r.. .€a 3.7 ' ,/..,,.r la..Y rr'rf /. : ;;. �rF�iome�mprav e -License �A�,. r. } a: r r �,r �,�� ,E✓,��xp�Dat�.���J,F ,,T�.r�� ��k�,7r���`r r.;:,,r, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ � FEE: $ Check No.: _� ��/ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to gi ra ty fund Signature of 6�db& _Signature,6f contractor F N®RTM _uown of : EAndover 0 . .„Wtr ® J442 261Z * ® h , ver, Mass, COC NIC HE wICK y1. S04TED I►Pa�,iS U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ................................................- 4,A(dl" 0r� BUILDING INSPECTOR ........................................................................... Foundation has permission to erect.......................... buildings on .................................... Rough to be occupied as ........................ .... ................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMITI I MONTHS ELECTRICAL INSPECTOR UNLESS CTION T TS Rough Service . ........................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. HOM K IMPRO V RM ENT CONTRACI: MEASE REM-)TFUS RAI FwnWwd mW WKINd by: 1'wanch Name: New Enghtnd Dlt te 5 11 /(15, ........... TI-11D At-LlomeSexvices, Inc. d/h/a Tho. Braimh Number 31 W8 Bwmn 141%, Unit 1,Sht-ewsbuq, NAA 01.5,15) TM We 875901376P) FeduM 1D W 7506M,160;VIE Lie 0 U 0243%RI Cant.lick 16427 CT W 0 11MM521 NIA Fhove InVrwemem Cownwwr Roy 4 1,26893 hoWUMM Adlws: J?— City Zip Toa chmnle Work Phone: 11(pine Phone: Cell Mimic: sz- --------------.......... Horne Addruss: (Ndmova sum hwasaHM Pways Chy State Zip H-n-mfl Addn.�ss(to rn6ve pQul cmumunkalions and Home MpH iWdalvq EJ I DO NOT wish to recej%q,,any juarketing emails Front The I kni1c,I)el)()l sr,, agp,ces to Ljndcr�jt,�iwd We owilers of Be prqvNy Imaied at the We instalhation ,adds and TIM Al-Home SaiwIcs, W (Ahe Hmne Depot") ayrccs to rill-nisli, delivel- :111d al-l-allple (tar the installation (-In0allation") or all lwaeriraF, describcd on the helov" and oil (Ile roie,,cenccd Spee Shco(s), all (,)I' Which W, hwonivorated into this columa by US lcTvT-t.,.nn-% niong, whh nylyaq)plicahle "),two Supoopma and Almnit Smmmwy alln&ed Mmo wid any Change Miny WrAWedvely, "Contract")s 9tppc�_gxw, ,341e "In!rdl 4 1- .c S -,.) "r K-)vr%l�,11 egbaprasat Itps Cov Ei'lwy Lows F1 — 1Y `7 :22 1V ............. 'S, hmoa�Ioll ]Gufter, Cover, F11"ll1r Doues ............... ]Gonel-,,/Covers FJ-Fmut rtopw�w --------------- Toi,fl Contraci Arnount ar fim ntt deinmit as lore i""I one-4 hi I d g lf,0 w Contract A 11-lom it (Awcwwr agmes than hwnNuamy urnmi comamm or we woo p.&.n "Al Inecute a UMPAW Qwlimt(, (Me " " Mo(hu nq "M NY N" KdWWWd Spec MWN) and pny any Walwe due. As MhnNq nwh CwMmwr mda Hd,, Clmumt aPvm 10 b0l"MY mW Pnearly NQp"daM 1W))humm&j.. The Honte Dcpot resaws We do, M KSLw a (Inge(Mler or lunninate thrix Cwamo �w jMy h" i7 pRA,W(,ys) h,IW,l h,,W, in MMM A Ple I hone DqPq x its audnival Sol%PMAW dnernines dim k cann(ol pcyj'a-)nll its obti'(1adow,clue to a siructunal jo,ohIcill with YIu,hume, olkrif(Alltllcolal herr wds stwh Is :UOW. adxsfox ur Inul rmint, otfivy Ivicin"-, cnol-s or hecause wcwk 1-cquircd to compIcic tho''job vvos lim inchl(k°d ill the Contract. 'I hC Pa"'HA-W SLIIMUMY U,112.AMR— hMmhd as put or Ns Cummy son Koh ale =1 A ( mmul ammu" Nvid jol° draw I,,) osit^ alld htUil PdY,,,cMs Iq PaWl (as all1kablo. 111,1,011,14-1TO CUIS,FW,41R You are MW to a PonWkidy HINd4u copy (tf the WWO a( the M!you sigm Do nW syn a I W00% (ThMeMe Me: Uicro is ono U(sinjAction Rw emb HMM P"WUN as &nmd WY hWkh&W SW Shmk) Mwe wwk on Owt Mwhwi is complete, In tilt-, pneui of kn-�Wnppmon Of Us (014W Whisinwr agrus up pay I.Jw kjonw Dep, "Ic MIS Of Ina lm lalmr, cxpense"', aml senKs prukhed by The Won lkyA w, AtHhorizu! SUM MAW tNwyh Hn dam nC vnWdsHKq phN my 00M, Anmmnu ,aa AM hHhK Agremumit or ="ed imMT apflivaldle Wm% THE HOVll,�' j\iAY, VVITEP101,K) OW111) '110 THE DET'01' 111H I)EP()srr invNivor oR ()TjjKt' I MIUMTHE EUMIE MUM U111EIt IMMEDIFS INN( RIAMERY OF SUM ANUMMIN. 1,MhmjAjMj MAnn allees mill Mromviv atal Wis Agmenwri; is & enke agumom heo,,, (nd rt g;a-d io the Pro(lu(,ts and limbillation scrviucs and all p6oi.discu,"'kitis and "tgrocillools, cither or;d or vvrutcllnd. hlq tip,surd 1huhms and h"WhOuLT[lis Agwumenil cannot it unigned cw wimricled evnIm by I w0hy syne(l by 00(mier am! Ile III= INToL (Apay-lypy wWW,j,W,S Uld ag"n duo 0istonar lin inki, undustaluk, wdponuvy acoTh w(, Wrnls of and hir,received it copy c&His Apaunmu, WA.a,j MCI i*r "Wilyd by; 5 CO- C VVINDOWSPEciFIrATIONSHIEFT - Spec.Sheet#: Sheet: -Of ---M-ek ConsultanC: int New Window Fxisting Window MLasurement.t; Glick Plod. Labor Hinge LocationsCt Ptions options From outside, I C',,tic Left to Right Color ROUgh Opening or bars of bars Boys.Bows, I -- Csrnnts,I PnJ, u s(I L,R or S cla�s Imic I tc n15 s H aCr'cl lav�v a r e Code For doors use SC reen Style Wrap, "S" stationary or rocarFl— Mull Code (%VN) St vie Code series code .9 0 7: operating 4� > x 0. -Zi > e: 2- IA/ q3 111, r LAj -70 1- ----- ---- l �-- 1 ) --- _ - r-! p whir SPECIAL CONSIDERATIONS: Bay or Boll,wi n dow: call I t-ri 11 Minyl only-P.,,ch II—EV�, tlac PIC-i-TIc,11 A,1I, (3 k) Pant,'1,rip--rDH —,tj Top,of J nd foj-fljnchc,) if and In-fFIt,-1-r nLoflfu mitt L! h,- relivied and agree with al;tJI,,joi, p­flc,­,Obova ard ho Corstrucl R..((Y, Sj)QciAi Terms and Conditions on rhe back of the yell—<Istumor)copy, Garden Window: I it_PIC11te,b,rc (),,k) Atzl Tnic Customer Sig"'t", Addir—il St,eff IYe&0,J,jal Whito-The,Home Dem Ydtow-Cuge,mcr - The Cominonivealth of Massachusetts Department of IndustrialAccidents _ — = 1 �oaz�a ess Street Suite 100 a Boston,MA 02114-2017 __~ I ✓V V1V.;Maass.Gov1diaa Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PER14TiTTiNG AUTHORITY. Applicant Information Please Print Lelribly Name (Business/Organization/Individual): T ?address: City/State/Zip: G' Phone#f: T7. R ` Are you an employer?Check the appropriate box: project(required): t. I am a employer with employees(full and/or part-time)-* ew construction �.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[ito workers'comp.insurance required.] �.� 9. Demolition I am a homeowner doing all work myself.li`io workers'comp.insurance required.]r ❑ 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractor either have workers'compensation insurance or are sole 1 L®Electrical repairs or additions proprietors with no employees. 12.Fj Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roo repairs These sub-contractor have employees and have workers'comp.insurancc.t 14. er ,.F 1,:e are a corporation and its otticers have exercised their right of exemption per tiIGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box,l must also till out the section below showing their worker'compensation policy information. 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 ant an employer that isproviding workers'compensation insurance for Amy employees. Below is thepolicy and job site informIation. Insurance Company Name: 11, 1 Policy#or Self-ins.Lic.#: ) ) Expiration Date: Job Site Address: 1� �c��� 1�/' City/State/�Zip: Attach a copy of the workers' compensation policy declaration page(showing the poky number and expiration date). Failure to secure coverage as required under NIGL c. 152,§25A is a criminal violation punishable by a fine up to S 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. 1 do hereby certify it er t e a'Is at d penalties of pef ju)y that the information provided above 's true and correct Sianature• Date: Phone#: Official use only. Do not write in this area,to be completed by city or town o7,cialE City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Elect6.OtherContact Person: Phone DATE(MIN-1r (YY) A EIi CERTIFICATE OF LIABILITY INSURANCE 02118!2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOVV. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: MARSH USA,INC. PHONE FAX TNO ALLIANCE CENTER Alc o Exl. A1C No 3560 LENOX ROAD,SUITE 2400 E-MAIL ADDRESS: ATLANTA,GA 30326NAIC:r INSURERS AFFORDING COVERAGE 100492-HomeD-GAW'-16-17 INSURER A:Steadfast Insurance Company EE26387 INSURED INSURER B-.Zurich American Insurance CO 16535 THD AT-HOME SERVICES,INC. Ham hiICo 23841 DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire ns 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-00374664&14 REVISION NUMBER:8 THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR POLICY EFF POLICY EXP - LIMITS !NSR LTR I TYPE OF INSURANCE I D WVD POLICY NUMBER MIDD MMIDDIYY A i X I COMMERCIAL GENERAL LIABILITY GLO4887714-06 0310112016 03/0112017 EACH OCCURRENCE S 9,0G0,000 ('��'� I DAMAGETO RENTED S 1,000,000 I CLAIMS-_MADE OCCUR PREMISES Ea occurrence LIMITS OF POLICY XS MED FXP(Any one person) S EXCLUDED OF SIR:$IPA PER OCC PERSONAL 8 ADV INJURY S s,aao,aoo GEt4'LAGGREGATEUMITAPPLIESPER: GENERAL AGGREGATE $ 9,000,000 POLICY❑PRO- ❑LOC PRODUCTS-COMPIOP AGG S 9,000,000 JECT OTHER: !BAP 2938863-13 0310112016 0310112017 COMBINED SINGLE LIMIT S 1,000,000 LI B AUTOMOBILE ABILITY Ea accident I ' ANY AUTO BODILY INJURY(Perperson) I S 4 ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED Per accident $ HIRED AUTOS AUTOS 1 s 1 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS S C WORKERS COMPENSATION WC015519215(AOS) 0310112016 03!01!2017 X PER ER C AND EMPLOYERS'UABIUTY YIN WC015519217(AK,KY,NH,NJ,VT) 0310112016 0310112017 EL EACH ACCIDENT $ 1,000,000 ANY PROPRIErORIPARTNER/FXECUTIVE NN NIA D OFFICERIMEMBER EXCLUDED? WC015519216(FL) 0310112016 03/0112817 E.L.DISEASE-EA EMPLOYE $ 1,000,000 (Mandatory in NH) 1,000,000 II yes,describe under Conitnued on Additional Page E.L DISEASE-POLICY LIMB S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi MukherjeeAti��'" ©1988-2014 ACORD CORPORATION. All rights reserved. -1 Armon ___ office of Consumer Affairs d Business Regulation 10 Park Plaza o Suite 5170 Boston, Massachusetts 02116 Home Improvement,Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2016 THD AT HOME SERVICES, INC. -- RICHARD FALLONE 2690 CUMBERLAND PARKWAY SUITE-- ATLANTA, GA 30339 Update Address and return card.Mark reason for change. Address J Renewal j j Employment 1_, Card CA 1 :_ 2NA-05;11 �7�r TGIi+JNr1ft�•gc(�/!l Cro'•"IGrlJa('f?!rJC�` rice of Consumer Affairs&Business Regulation License or registration valid for individul use only `midw before the expiration date. If found return to: 17ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation =-fegistration;=126893 Type: 10 Park Plaza-Suite 5170 Expiration g/3/2096 Supplement Card Boston,NIA 02116 rHD AT HOME SERVICES 'INC rHE HOME DEPOT AT-HOME:SERVICES RICHARD FALLONE 2690 CUMBERLAND PARKWAYS -- 'S' N�`A,GA 30339 Undersecretary Not lid wi hout signature 27 . ! . . . /RJ « . 0«12¢}§) », < ~ 2,' 018 ( �\ .a= lo«% ,/ �