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Home My WebLink About3 REPLACEMENT WINDOWS (2) ti4ORTH BUILDING PERMIT of TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION V`' Date Received Permit IVO. 5� Date Issued: � �l I PORTANT: Applicant must com Tete all items on this page SSRCHO 1'R11=RT1rOWNER .. , . t Pn MAS NO � PAI�CEI� `>�QNI �DIBTR.I�T H�sfot� l��strt�lr s r�o IVlcl � pI#ale oto TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential i::] New Building L] ne family Addition i Two or more family Industrial enation No. of units: Commercial epair, replacement Assessory Bldg Others: I:. Demolition Other ept c Wi II Floaap itr� �etlandsDtstrlct Identification Please Type or Print Clearly) OWNER: Name: VLIAV, Phone: a Address: � 001`1 M. �a Pharre' Addess Bolos Ooze � t � �__ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $_ _ Check No NOTE: Persons con a t n � -- - Receipt No.: g with unre :istered contractors do not have access to the guaranty fi1nd B�gature cifq. rrtfOur�el= igrattre cif contactor tAORTH Town of �= ndover p No. z h ver, Mass �a coc"It"Rwo[K 1' ", Q ` p°4ArED S U BOARD OF HEALTH Food/Kitchen I T Septic System THIS CERTIFIES THAT J� BUILDING INSPECTOR .................. .. .... I.. ............... ......... ..................... has permission to erect.......................... buildings on . ..... �� .... '......,............ Foundation ..�:.�.�.-�1.. �� .... .... Rough tobe occupied as ............ ... .. ..:....................>...................................... Chimney provided that the person accepting this ermit shall in every respect conform to the terms of thea application pp 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PER T D Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO Rough Service ., .... . .. ................ ..... ....., '"' Final BUILDI INSP CTOR GAS INSPECTOR Occupancy .hermit Required to Occupy Building Rough Display 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. 71If314'I>C IMPROVEMENT PLEASE READTHIS Sold, Furnished and Installed by: Branch Name: New Engulf] Date: I l_,r THD At-Home.Services, Inc. d/b/a The Moine Depot At-Home Services Branch i urnher: 31 908 Boston Turnpike, Unit 1, Sitrcwshury, NIA 01545 Toll Free 877-903-3768 l','cderal ID 175-2698460;ME Lic#C 02439;Rt Cont.Lie# t 6427 CT Lic#HIC.0565522;IMA Home Improvenicnt Contractor Reg.# .126893 Installation Address: # � City State Zip Pni'cliaser{s): - work fltone: Home Phone: L+1 Cell Phone: Home Address: 0(different front Installation Address) City State Zip E-mail Address(to receive project comrininicat€ons and blame Depot ablates): ❑ I DO NOT wish to receive any narketirig entails from The Home Depot Pt•aject hlfctrnuttiai�: Undersigned ("Custonler"), the owners of the property located al the above installation address, a1grees to buy,, and THD At Home Service~, lnc, ("The Monte Depot") agrees to furrtish, deliver and tu'r<tuge for the installation {"Instailatiuia") of all materials described on the below and on the. referenced Spee Sheet(s), all of'which are incorporated into this Contrite€ by this , reference, along with any applicable State Supplement and Payment Stnitmary alwe.hed hereto and any Change Orders (collectively, "Contract"): Job 4f: (twtr,r;ir xvrereict) Products: S)ec Shcet(s)39 #: l'ro,ect Ailu)un4 t Vi mdoti+'s ❑ lasulation q' Z,,, ❑(;utter~/Co�'ers ❑Lnit'y L�octra ❑ � � �� ' ❑Rclohng ❑Stdint.� ❑ 1Vindous 1)lsulatinn ❑Gutters/C'overs ❑Entry Dc�rtrs ❑ ❑Rooting ❑Siclittg ❑ 1�47ir)dows' InsulrltinilT .. �. �---____,�.�._....._.. ❑Clutters i COVet-s ❑Enu'y Doors❑__....._ _._.� ❑Ranting Stelrlt�r r _. _ _'__ �_ ___.__. ._...._.. ❑l�tttclows ❑ ]nsulalinn � ---._��_� I ❑flutters l Cmus ❑I n1i y Doors ❑ ,.,_ ., _ i �Iinitrinui 2_w`%TBr p(ssit of Coat►act FAntount flue np(ri)execution oI'tltis co)ih•act. $ ;~'lame Pur lutser^s iiia),not deposit more thall om-blind of the Contr€1ct Auinunt. Tata! C:tintraet Amount t� Custonler WWes that, immediately upon coittpletic:rl) of the wort: for each PrOdui:t, CnSt01t1e1- will execute a Corliplelion Ce:ti#icate lone for each Product as defined by aii individual Spec Sheet) wid pay any baku)Ce. flue. As ,ipphcable, each CttStfMACr tinder this Contract agrees to tie.jointly and severally ohli� tied and liable.hcroululer, The Home Depot reserves the right to issue a Change Order or tonilinate this Contract 03,any individual PrOduCt(5) included horeiu, at its f1kcretiou, ii'Tlw Home Depot or its atilhorizcd service provider determines that it cannil€ perform its obligations due to a s€ructural problem with the home, environmental hazards such as mold, asbestos or lead paint, other .safety concr-rns, pricing, error's or because work rcgrih%4d to complete thc.job was not included in the Contract. t'aj�� The Payment St.tnilwiry tr_.J-1 o � included as part of this Contract, sets forilt the tolul Contract amount and payment,,;required t«r the deposits allyl final payllwilts by Proclucl (<ls applicable). NOTICE TO CUSTOMER You are entitled to a completely felled-in copy cif the Contract at the tine you sil:;n. 1)[t lit>t.sign a Completion Certificate: there is alke Completion Certificate for each tl,§ted Product as defined by lii(hvi(lual Spec Sheets) beet ire wOj,k all th2t 1193.0(Ittct is eonnplete. Iii the event of termination ofthis Contr)ct, Ctlstotner agrees to pay The Ronne Depot the costs iia lliateritrl.s, 1tjbot', c�lae.tt5es Mid services provided i)}' The Home Depot or Atltli[)li7,ed Service Provider through the elate [lf termillaflon� Bills any otfie-r ainlount, stat forth ill this Agreement or allolvecl tntder appiicalb10 lata'. THE HOME DEPOT MAY �VIT..1-II-IC3I,f)AMOUNTS 0"'E'D TO THE 1I5.}ME DEPOT FRONt THE DEPOSIT PAYMENT OR I3'I'HER PAYiblENTS iVIADE, WITHOUT Lfi'VIITING THE'1-101ME DEPOT'S f3`I`HER ItR;N'1E DI S FOR RECOVERY OF SUCH fyIME)UNTS. �c el)taque and Aillli(ii'Ization: Cuslonler wrccs aild nRCI('I'.51:111d5 111,11 this ALwck'1110I1t is the cifli C riort'E'tnew b twe..en Ctisioincr and The I1ortte. Depot t�ith re��ard to the Pr(3cluus and lnstallttli[sn services alnd supersedes all prior iiaxcussionS nrtd agrccilaents, either oral or w)Itten, relatinuo (o Said PrOdUC 5 and Installation. This Ageeinciii cmmot be assigned or amended except by a writing si4.,11cd by Cttstollier and The Home. Depot. Customer acknow-led-es and agrees that Clistonler has read, tlnde.rstMd,';, voluntall'ily aec.ept5 the terms of turd has received a copy of this Agreentcm. ,accepted p Submitted by - Mw-- _ ._ 2 1 x __ The OmInOnwealth of ryCcassachusetts r DeprartMent of CndustrlalAccldenis 1 Congress Street, Sufte 100 Boston, M4 92114-2017 www mass.gov/dla 9L',kers' Campan:saiiun insurance Affidavit:Builder3!ContractorsIR1Utrtci1n3lPlnrnber3. TO BE FILED}=THE PER'k1I1"EING AUTUORITY. A licant Information Please Print Legibly 1CCle (Etusiness/Organizatiar�/lndivtduai); f�CjCll`�SS: City/State/Zip: ff: Ar�youaplayer?Check The appropriate box: Type of project(recluirzd); ployer wilh�empioyees(hill and/or part-time)," 7. ❑Now construction 2.❑l ane a sale proprietor or partnership and have no emptayaes working Forma in 3. ❑Remodeling any capacity,[No workers'comp.insumnco required.l 3. 1 am a hamea\vnor doing all work m self. t 9. ❑Demolition ❑ g y (Na evarkcrs ramp.insurance required.! 4, t am a horneovrner and wb e hiring antractom b conduct.all Wolk on nt ro !0 Building addition ❑ dl hig c Y P Percy. [will ensure thatall contraclorsaithcrhave workers'compensation iruuranco orma sofa l€.❑Electrical repairs ar additions proprietor;Willi no:mployeas. l2,❑Plumbing repairs or additions 5.❑l mn a genaral contractor and T hays hired tho sub•contr-actors listed on tho attached shect. l3. R re airs These sub-contractors have employees and havo evor'scrs'comp,irrsuranca.t ❑ p 5.❑We are a corporation and its officers hava exercised their right of oxemplion per Mf.c. 14. Othe[ 152.q IN,and We have no employees.[No workers'camp,insoremce required.} Any applicant thatchacks boxfl must also M . ...._out the section helQ%vshowing t dr worxars'camperuation policy inl'amratiun.. t Knriieawnarsrtta siilinit this afl"tdevit mdtcating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. l'Conlractors that check this box most altaacd an additional sheet showing the name ofth*sub-cgntractors and state whether or not those entities have employees. If the sub-conlraotors have employees,they must provfdo their evoriccrs'camp,policy number. ram an employer that is provldIng workers'contpensattah taasuraaice for my employees, Helotp is the policy and job site Inforrrtaflott. l Insurance Company Name: t.�- r Policy t#or Self-ins: t# Llc, : UL��_ L Expiration Date: Job Site Address: Q City/state/Zip: Attach a copy of the workers' co pa' ti alley declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c, 152,�25A is a criminal violation'punishable by a fine up to$1,500.00 and/or one-year imprisonment,as Weil as civil penalties In the form of a STOP WORK ORDER and a tine of tap-to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DFA for insurance coverage veriflca. I do hereby cer fy in er re pa is and penakles of per)ury(fiat the lrrforinallon provided above k true and correct. Signature: 171T Date, Phone fl: Offletat use only. Do not Wille In flits area,to be completed by city or lawn ofjlclal. City or Town; PerinitUcense 9 Issuing Authority(circle one),. t.Board of Health L Building Department 3. Citylrown Cleric 4.Electrical Inspector 5.Plalnbing Inspector G.Other Contact Person: Phone ds.. "� CERTIFICATE OF LIABILITY INSURANCE D02/24/2016n��) 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 CR'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 Perms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer fights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHOH o FAX c No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GAA 30326 ADDRESS; _ SNNStiRERt54RFFDRf34NO-GOVERAGE -_�__�_ _Nh1C#- 100492-HDmeD-GAW146-17 INSURER A:Steadfast Insurance Company _ 26397 INSURED THE HOME DEPOT,INC. INSURER B'-Zurich American Insurance Co 16535 HOME DEPOT U.S.A.,INC- INSURER C:New Hampshire Ins Ca 23841 2455 PACES FERRY ROAD,NW BUILDING C-20 INSURER D:lilinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL•003741310-08 REVISI_ON_NUMBER:O _ __ _ THIS IS-T-9 CERTIFY THAT'THE POLICIES OF INSURANCE L15TEp BELOW HAVE-BEEN ISSUED TO THE INSURED NAMED A13OVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CE=RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITLONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDI-SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD1YYYY MMIDBIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL048877i4-06 03101/2016 0310112047 EAOH OCGURRENCE 5 9,000,000 TE CLAIMS-MADE �OCCUR PREMISES EDAMAGE TOREg occur ence S 1,000,000 LIMITS OF POLICY XS MED EXP(Any one person) SEXCLUDED R C:f SIR- PER OCC PERSONAL S ADV INJURY 5 GFN'LAGGRCGATELIMIT APPLIES PER: GENERAL AGGREGATE S 9,000,000 X POLICY PEa ❑LOC PRODUCTS-COMPIOPAGG S 9,OOD,OOO OTHER: S S AUTOMOBILE LIABILITY BAP 2939863-13 03/0112016 031OV2017 COMBINED SINGLE LIMIT S 1,000,000 Ea accfd" X ANY AUTO [ I BOD$LYINJURY(Per person) 5 AUTOS LIED f 4 SCHEDULED �"EI F INSURED AUTO PHY OMG 130DILY INJURY(Per accident) 5 1 W04-OWNIED :ROPERTY DAMAGE "HIRRDALITOS AUTOS PeraCCldent a S UMBRELLA LIAROCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED I RETENTIONS S C WORKERS COMPENSATION WC015519215(AOS) 0310112016 {1310 1120 1 7X PER WH- C AND EMPLOYERS`LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE WOM6519217(AI(,)(Y,NH,NJ,VT) 03101/2016 0310112017 EL.EACH ACCIDENT S 1,000,D00 nFECERIMEMBEREXCLUDEO? N NIA D ;IAandatdrylrr,NH). 1"1C0155.i921G(r=,L) 0310112016 03101.2017 EL.DISEASE-EAEOPLGYE S 1,0(kW6 IF ges,describe under Continued on Addilional Pae 1,ODD,000 DESCRIPTION OF OPERATIONS below 0 E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,AddlNonal Remarks Schedule,maybe attached IT more space Is requrfed) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16MOSGOODST. THE EXPIRATION DATE THEREOF, NOVICE WILL BE DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUT14ORIZED REPRESENTATIVE or Marsh USA Inc. Manashi Wilrherjee O 1988-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ^ . - 06006 gpgp'{{� yl�q� pp��53 �- Pl c 6 0211 11201 u u 0 I q r�ly i/ r B U51 AMdE3 an,:', D�3 5 offic-� of COL-15-ura, S uit, 5170 t-ts Bo5tori, MqJpcthus-t 02116 e L Home IMP tOvemditg-gatractor Registration .......... flon: 128893 g S tr a card Type: Supple n THD AT HOME SERVICES, INC. RICHARD FALLONE 2590 CUMBERLAND PARKWAY SUI�TRE-51' ATLANTA, GA 30339 for Change, On Lila rk reason pdate Address and return card. Address Rane)V-a[ [j ZMQIDYUlent Lost Card flee at Consumer A.Mirs 13usiaess Reauhl'tiou License Or Mu�istration valid for indNidul use GOY -a - before.Clio,expiration date. If found retiLrn to; IE UMPROVEMENT CO iNTRACTOR Offlee D[consumar Affairs and 3019ess RM.MMIOU Ty P-3: to paric'Plaza-suka 5110 c Qagistratiost: 1?6893 NLk 01116 D AT HObIE SEMI= T.-ROM�KSE 9Y IC E S E HO.M E DEPOT �HARD FALLONE -EU go c-UMBERLAiND PAROEXY Not Rdwi nut signature GA 30339 Unde rseerefary