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Home My WebLink AboutBuilding Permit # 7/13/2016 k pORTy 9 BUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: SAC HitSE��y IMPORTANT: Applicant must complete all items on this page ll, R ISO FAIEL � fTRT. l ltt Da & TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential New Building _ ne family Addition F 1 Two or more family -1 Industrial eration No. of units: I Commercial - Repair, replacement 7 Assessory Bldg ! Others: Demolition I I Other Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ofo F , ARCH ITECTIENGINEER— Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $__ 1, [0 FEE: $ a Check No.: t e'5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access the uaranty fund 5i rtat re"of Actent1C? rner _ ; �_ ` Ignatt�� (?f, * rttfa 0ORTy own of O No. -r �a LAKE h ver, Mass,0�1 1 Za cot"It NEwic V Q°Rwr¢n S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System t THIS CERTIFIES THAT � �. .. 01......,. ` o'"� BUILDING INSPECTOR has permission to erect ... buildings on ... P�d �,',,k1i Foundation ....................... .... .,, ,.,................... g ft Rough to be occupied as ............... .... �....................,...................,..............,....,,. Chimney provided that the person accepting thi permit shall in emery respect conform to the terms of the application Final on fife 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST N S Rough __— Service .. .. ..... ... ..... .................. ..... Final BUILDING IN ECT R GAS INSPECTOR Occupancy Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises - Do Not Remove Fina` No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 110MV 11111*l40NA`,N1I:NT CONTRACT Pi,I'ASE: RRAI)TIIIS r» Solo.Furnished and Instnilcd key' Itrnatl'I1 Nilrorl Netr 11,14A xhnld Dale;„ ' l lD At-)loolc ticrvaccs, Mc. Ifrlrurh Ntrnlbvr;,ii d/b/aa The Forme.t'Dcpoll Al-1101110 Services 908 Bowtoa'Taarnpike, thlil I.Silt ewshury.MA 01545 Toll Free 877903-3768 f^otleral 117 11'75-201>8460,h'11;Li40('02,431),RI Coo t.iOl 16427 1 ^, ��CyyT I i It Iltc'Ir5655?2;NIA Ilomr lmlitovemew t_"lrallr°icroi {ick.U 1'26891 Instnilallun %4lJjrv,., �Gf - .� ,r-1-, _ State Zip purr°ilrlscr(s'1; Phone: Work1"tome HFrrnu:lahuCnr, Ull o Manic Aoldvt` sa 4Itdillcivill I't'oin lustallatu.m Adchc.ss) City p Still ftp Address flit rcccitc irroicct comrininicadrins and I-Iomc Depot updates)14-1 m r"fit►1�at 01 to rcccrvc ally trlurket'iug cntaails from The home Depot r V4 r'1,�h.11ltrrr")knitiratYt l lodorsigned("Cirstorner"i.tilt owners,or the irroperty locaaled at the allove installation unodfrC2�rocsito buy. ( �irstold I"Mi 1l- 11,'1 scrviccs. Irl(", `I'le Home )stmt" agrces teruntish, deliver and arrange For the ulsiallatiaoil") of all mawvias tiv,,,ibcd on 1110 Mow rad oil Clic relcrellced SPCC Shecl(s). all of which alrc urcorlaoraled nuo this Contra by' IlliS !,06vol,c, iiloag, with aloy applicable Stake SupplCnacut alld Payment Suruulary;ttlaiched hereter and uny Change Orders(c:ollecnvcly, C'olltkolet"1. uetlrua,1 1 r(glucts: Sec Shctl wsl fid ►'ro cr7l Anururat_ v_ __ ___.__w �. ^y } f4lruling ❑,ei, , i 1Vnaaiuw hasul Inuit lX � / /5 / 7� /C lararti �]f n117 t7ltFtr�v �l._ � L 4./��.�'W'` lln; Wfndlsws t [� �Crlvular[irrrt ^y __ l✓1( tl /rr (ut I s Ut nary 17Frltrti 0_ 1._JlzioolitF1! { ,J�i 141111t.Y, L,,,, wi to4t11wti fIF',111 i11 b11K4 Eluutcls/Cowl-S Ell4naryDoors C)l2aartinti MufMg 0 WinJnww fllwulnucrn [ ]Cirrtl.t:ti/c"w:rt'rry Ql:nlr' Dokv.s C1 Minhalum 2511,IDvpaH fl(arContmet Amouut dile upon cxcwutimi of"t'his e(oatrtio. Total Contract Amount 1 . - 1 tar)ntr}"aut'1uarur+raauy nta tivlaraal rrrrlCe taunt unr411airrl ol'the C'nliimrl Arnutlnt. I, Clislorner agree" that, innncdialely upoll complcuon of*fisc work for each Product. Customer will execute as CoMplelion Certil"ieanc (erne For cach l'rroducl ats dertittctt try an individual Spec Sheet) am(1 filly ally b.11MICe(It)e As applicable, each Customer under this Contract agrees u)by joiudy lord scver'allly obligaucd;rid liable hCrQlnider, Tho Fiume 170por reserves flit-right III issue a Change Order or terminale this Contract or ally individu.rl Produet(s)included herein,at its di,sciclioll,it'I'lle Home Depot err•its authorized service provider determines thal it cannot perform its obligalions clue to a structural proNcul with flit,home, cnviromnernul hazards such its mold,asbcstos or Iced paint, other safely concerns,, pricing errors or becaust- work rc'yuirccl to ct)rllplete the job wars runt hlcluded in the Contract. t'avnlent UStlinnlarv; Tile payment Surmil ary fi,...__ ._- .—. inducted ars part.of this Contract, sets fortli tile loual Contract aunount turd payments retpdred for dic deposits cart(.]final payments by prochict(as applicable), NOTiCE`ro cus'r(mFR Voll tiro elititiv(f Irl lk completely rifled-ln copy"of,like Conirael at the time you sign. Do not sign a Completion Certificate(note.: there is true Completion Certilkcate fill-each listed Product as delinedby individual Spec Slaeetrs) bel'ore work oil that Product is viompictc. In the cmvnt or terkuinalloo cri"ibis Contract,Customer algrees io pay The Flrnne TDepot the costs or materials,labor, elpelkses and services providerd lay The hams IDelaof for Aulhol"izcrl Service Provider Ihrotigh life (]aIle of termination, pilus any other aunuunts Sri forill ill this Agi-cvulckli or atlharcr(l llodev applicable lana. THEliC)i1 E DEPC)T MA1 NVITIMOLC)ANIOUV'TS C7WIA) TO Till.: 110)*\I ; DFIIOT I'RC7Ai 'I'III, DEPOSIT PA NIENT ort ariint PAYMENTS MAF:}U, WI" 14.)U'r 11,01616ai'C.,`["III'[HOME IDIA10 T'S OTHER RVNIEVIES FOR RECOVIERY OFSUCH,,ANIOf1N"l'w,'. Avvee,�s_taanc�v_atnd..Alit hrniZiff loot): Custoriirr iigrees and under.Mmids th:u this A ,rcemeril k tile cntire npreement between Customer ilea 'I'IrC c 1-bmw 0opot tvitT regard to the products and installation services and supersede"till prior fliscuvxiools and agreanecnts,either orifi or wrillcn, rclaun" to said product, mid installation."this Agreement caaanot be ars;lgllCil or unrco(Icd CxCCpf by it Wri(ilig�,srglled h1, C'ustorucr and'I l7c NoaliC ))(peal, C'uxtorner aat;know)c(Iges and agrees tilalt CutiEorl Zld_urldersuuids, Voluntarily accepts the lcrurs(it and has reCCINed a copy of this Agreement, Accepted , . Sul n' eel C us�u( s `igl(an e Date Stiles Co ;+all rlt' . ren; t,in�t( X _ Telephone No. C,ustomua s `iignaturc Dille Sates Consultant License Na. CANCELLATION: CUSTOMER MAY CANCEL THIS Caavnppticaabtcy AGREIVNIEN'I" WI'1'I1C)i T PENALTY OR 0Il1,i(:A'ri0 N BY DELIVERING WRITTEN NOTICE TO THE HOME D1,110T HHV NIII)NIGH`H' ON THE THIRD IHIISININS DAY AISTFR SIGNiNC THIS ACRIWMEN'T, THII. STA'TE'. SUH'111,FNIEN'T ATTACHIED HiCaIIET(? t'0NTA INS A FORM TO USE. Ila ONE IS SPE:("IFICA IA,V PRESC:'RIBED IIY LAW IN CUSTOM E14 S STATE, NOTICE':AIMITIONAL TE CAIN;AND CONDITIONS hitt+'STATED ON TllV R►ivlit SE SIDE AND ARE PART Ota'I'rltS CONTRACT 09 03-i5 Whitt,—Branch File Yellow....Cuslomm The Commonweal!!, ofMassaciruseas Department Of 111dustrialAceldenis UW 1 Congress Street,,Suite 100 Boston, MA 02114-2017 www.mass gov/dla Workers' Compeasatioa Insurance Affidavit;Huifders/Corntractors/Electrieians/Plumbevs. Applicant Information. TO BE PILED WrM THE PERnMING AUTHORITY. Please PFirlt Legibly ibl Name (Business/0rgaaWtion/Indivtdu l);- Address: City/State/Zip; Phone#: Are you a player?Chtek the opproprlato boar., I. I am a emptayerwithemplayees(full and/orpart-ilmn).o Type of project(required); 2.0 I am a sola propdotor or partnership and have no employees working forme in 7' Q Now construction any capacity,(No workers'comp,irtsurarrce required.] 8. ❑Remodeling 3,Q I am a homcowncr doing all work myself.[No workers'camp.insurance required.]I. 9• ❑Datnolltloa 4.Q 1 am a homeowner and will be hiring contractors to conduct all work on my property, I will 10 []Building addition ensure that all contras fors either have workers'compenmiron insurance or are sole proprietors with no amptoycas, I l Electrical repairs or additions 5.0 1 am a general contractor and I have hired the sub•cantmetors listed on Iho attached sheel. i2.❑Pu m lg repairs or additions These sub-contractors have employees and have workers'comp,insurance.! 13. oaf repairs &.Q We'arc a corporation and its officers have exercised their right of.exemption per U%c. 14.Q Other 152,410),and we have no employees.(NG workers'camp.insurance required,] *Any applicanl that checks box#I must also ESTI out towing their workers'campensalion policy information, t}fameowners who submit this affidavit indicating they ern doing all work and than here outside contractors must submit a now affidavit indicating such. 1Conlraators thatcheek this box must attached an additional sheet showing the name.ofthe sub contractors and slate whether wnot those onici ti g such, emptoyecs. IFthe su[reanlractors havo employees,they must provide their workers'comp,poUoy number: or I am an employerthnt lsprovlding workers'canlpensallon Information, Utsrrrance for nfy employees Below is III policy rindjob etre Insurance Company Name: r � Policy#ar Self-ins].L[c, #;—Wl r Expiration Date; Job Site Address; - Cl At#calx a copy of the workers' compensation policy declaratlan page(showing the policy number and expiration date), Failure to secure coverage as required under MOL o, 152,§25A is a criminal violation punishable by a fine up to$1,50o.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up'to$250,00 a day against the violator.A copy of this statement may 6e forwarded to the Office of Investigations of the DIA for insurance coverage veetflration I do hereby cer y it a the It d penalties of perlary Am the information prnvlded above is true and correct Si afore: Date! Phone#; Offlcial use only. Do rtol wrlfe In tlils area,to be coritpleted by city or town offlclal, City or Town: Permit/License# Issuing Authority(circle one); 1.Board of Health 2;Bullding Department 3.C4/Town Clerk 4.Electricai-Inspecter 5,Plumbing Inspector b.Other Contact Person; Phone#:.. 'OCC>R" CERTIFICATE OF LIABILITY INSURANCE -DATE(MMlDDNYYY) 0RA00113 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOI.UERf IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, Subject to the femis and conditions Of the policy,certain policies may require an endorsement. A statement on Ihis certificate does not confer I-igiTts to the certificate holder in lieu of Such endorselnent(s), PRODUCER iCONTACT MARS$I USA,INC. NAME: TWO ALLIANCE CENTERPHONE — FAX 3560 LENOX ROAD,SUITE 2400 JAd.CpNo.Exr1 ATLANTA,GA 30326IL WC,Not: ^ ADMDRESS: -_ NSURER(S)AFFORDING COVERAGE NAIC r€ 100492-Hor_neD-CAW'-16-17 _ INSURER A:SleadfasllnsuranceCo€ltpany 26387 INSURED _ THE HUNEE DEPOT,INC. INSURER B:Zurich American Insurance Co — J6535 _ HOME DEPOT US A.,INC. INSURER C:New Hampshire Ins Cu _ 23841 2455 PACES FERRY ROAD,NW BUILDING C-220 INSURER 0:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: _ ATL-003741310-08 REVISION NUMBER:O THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW H. .'_...__...__._ . w..._ _._.__.�_, ABOVE AVE 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. IN SR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE2NSD VO POLICY NUMBER MM100'r"YY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL04887714-06 03/0112016 03101/2017 EACH OCCURRENCE S 9,004000 CLAIMS-MADE OCCUR OA AGE TORENTFD PREMISES(Ea occunersce} _ S 1,000,000 LEMITS Dl POLICY XS rd ED EXP(Any one person) _ 5 EXCLUDED C-,.;,''.$i M.FT C(:)GC PERSONAL E ABV INJURY S hx"OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 9,000,000 POLICY PRO- JECT LOC PRODUGT"S-COFrfPlOPAGG S9,0(),000 S [3 AUTOMOBILE LIABILITY BAP 293886313 0310€12016 03101120)7 —COMBINED SINGLE LIMIT S 1,000,000 v - ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SELF INSURED AU'r0 PHY DM;G AUTOS AUTOS BODILY INJURY(Per accident) 5 AUeROPF.RTY DACAAG'E 'I11EtCii i05 AU}Oy Per acUdenf 5 UMBRELLA LIAa OCCUR ^ EACH OCCURRENGE S ^ EXCESS LfAB CLAIMS-MADE AGGREGATE 5 DED RETENTIONS 5 _ C WORKERS COMPENSATION WC015519215(AOS) 0310$12016 03/0112017X PER OTH- C AND EMPLOYERS'LIABILITY Y/1 STATUE ER ANY PROPRIETOR/PARTNEWEXECUTIVEWOO 15519217(AK,KY,NH,NJ,VT) 0310117.016 03/0112017 E.L.EACH ACCIDENT 5 1,000.060 OFFICERIMFMBEREXCLUDED? L NIA D (rdandator7lnF]H) WC01551921t(LL) 0.':10112{116 03,'R112017 ,-..., If yes,describe under E.L-D15L --EAEMRP-OY a 1,Cii3w DFSCRiPTIMI OF OPERATIONS UelmN Conti€ned on Addlliollaf Page E -DISEASE-POLICY LIMIT I 5 J,OCO,OflO DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 191,Additional Remarks Schedule,may be attached If more space Is requlred) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16r005G00D 8T THE EXPIRATION (TATE THEREOF, NOTICE WILL 138 DELIVERED IN NORTH ANDOVER,MA OIB45 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mokherjee 1�irn�,ti.ara ti c a� r t ©1965-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 511712016 IMG_0876.JPG r Anc � r S J 3 h s ` P r F• Irv• )' � r✓' � � i"` � fa e i � r. https./Imail.googie.comlmailAVON nboxd153a69e5ca11ae99?projector=1 111 /N? Office, of Corisumec Affairs and B tt s ines s Re 21, 1 lEati 0 L" 10 p-,jrj<, Plaza - Suit-R, 5170 Foston, Mq,§Pac-h1TS,--,Lts 02116 Home lmprove-mOt r Registration ,IC-ptracto Degistfation: 126893 Type: Supplement Card Expiration: B/312016 THD AT HOMESERVICES, IN RICHARD FALLONE 2690 CUMBERLAND PARKWAY SOIT-E-6 ATLANTA, GA 30339 Update Address and return card.Mark reason for change, Address ,—I Renely'al 17 Employment Lost Card flee License or registration valid for individul use DRIY- MIN Z before the expiration date. if found return to. !%WME[YIpRoV-EKENT CONTRACTOR Office of Consumer Affairs ana Business Regulation egistraflan2 Ty pa: 10 Parlc?laza-Suite SL70 L_1 Supplement Carl Boston,NU 02116 I)AT HOME SERV1dEMjt1`1Q:W7- IE HOME DEPOT kT-.Fff9LCM1 FV\IICES ICHARO FALLONE 390 CUMBERLAtNE)PARK-A Ay S L Not lid of hoot si rture GA 30339 9