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HomeMy WebLinkAboutBuilding Permit # 8/24/2016 TkORTNI BUILDING PERMIT TOWN OF NORTH�@�. ANDO W�®ER APPLICATION FOR PLAN EXAMINATION * .2 A n- Permit No#-. � � � Date Received Date Issued: Y ORTANT st complete all items on fids page `"3- ��;����✓✓a'� mow` �. ��,,"''�^ ,. .� �w ,�r�. _.,�;. � � i i��� P ,� � �' „'�,%�a". �„,,;' �:�'�Y ,'� '�" HiSOC[C SfIGt YeS ? n0 EMAP � PARCEL�� .rte, s ' ter r Maclifne Shop VIfag ,yeses no - r ,fie;;g-y, ,>�.;:i!'.;. TYPE OF IMPROVEMENT PROPOSED USE Resi ial Non- Residential ❑ New BuildingO 'le family ❑Addition ❑ Two or more family ❑ Industrial ❑ ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other f❑ Se tics ❑TVIfel1 YC] Floodplain« -❑Wetlands ❑ 11Valersfhed3®'is#rtct p F r 5 zG rs, c °fin rp av � x s' G , i �� T'�"' 1' � a :a:.-o' - s`..e ?y�" r✓. "u ,.rM✓a .,�. c x- Vllaterl_Sewer.; � DESCRNJ W TO BEP RFORME nti£ieati n- Please Type or Print Cleary OWNER: Name: Phone. Address: c ✓ Phone � ' Gantractor Name � s l �` j Fr w-""`r`. "'g��,a- r^r'?e ,''' �.t:r"""' ,. '-`5i'*' r, `"'�i,air'' a::e' '�, eye „�.( �.,y,.✓'�, e ., .,..F a�' e�'w V ��s�a.,��' ,.'., ,?. ti - .' r ✓ u `Su erulsor�s�Construcfion LEcens� � �,�� -� � �� � � Exp Date a � a � � r i��,� !,'`..�'� �,,' ''F:?w'%�,.:".:.s�' �`�w�'i �'`���:r...F" o- .,.: � ,..z � e� i.� :,a'`'.✓ ��'�v �; � ', ��ur '�a�. `""`u��r�',;;.7r y < `��Home�lrn r•oiremen�t License � ;� ,". .� �`� � _,,.: p_,.�,x. '. �� �� �° ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT-'$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project;Cost: $ l � j FEE: $ Check No.: Receipt No.: �� NOTE: Persons contracting with nonregistered contractors do not have access to g ar and Signature of Me,ntlOwner --- - - i naturp of contractor ,' - W. NORTy Town of :i _ 6 ndover r� I.- A— O _;M No. *YJ16 so h ver, Mass, s COC NIC Mr WICK Y Ab S U BOARD OF HEALTH Food/Kitchen PER D Septic System THIS CERTIFIES THAT ......... ,,,, BUILDING INSPECTOR ........ ... ! ........ ... . ............... ................ qM has permission to erect .......................... buil 'ngs on ... ... .P ..VJr64*.4..�a-.................. Foundation ' Raugh to be occupied as ........... .... ... ! .`'R. ........................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO Rough vice Final BUILDING IN CTOR GASINSPECTOR q V Bildin Rough Occupancy Permit Required to Occupy u ,� , 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. kii HOME IMPRO s PLEASE READ THIS Sold,Furnished and Installed by; a � THD At-Home Services,Inc. Branch Name:New England Date:_I_ J d/b/a Tile Home Depot At-Home Services A 01545 Branch Number:31 9t)8 Easton Turnpike,Unit I Shrewsbury, r877-903-3768 rod Free Federal ID#75-2698460;ME Lic#C 02439;RI Cont.Lic#16427 a Lic#HIC.0565522;MA Home improvement Cor Tactor Reg.it 126893 installation Address: City State dip wF, Purchaser(s): Work Phone: Home Phone: Cell Phone: Home Address: City State zip (If different Pram Installation Address') E-mail Address(to receive project communications and Horne Depot updates). D I DO NOT wish to receive any marketing emails from The Home Depot Proiect Information: Undersigned("Cu tomer"'),the owners of the property located at the above installation address agrees to buy, of "The Home es to alldm materials describedronelhe[bele w and on the referencedeSpec Sheel(s),alldeliver of which areincorporatedinstallation this'Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change orders(collectively, "Contract"): roducts: Pro ect Amount Job#: noremer rt�rrrcm<t S cc Sheet(, #: Roofing=Siding Windows Insulation rag d�lwyj ©Gutters/Covers G Try Dorrrw ❑ /t/ ( ( u ✓""" Roortng Siding Windows Insulation $ r Joutters/Covers OHntryDoors ❑� (xaxrfirrlt Siding Windows�Q InsulaCiait � � (7Gutters/Covers C1[niry Doors EL- - Rooting Siding Windows hrsulation $ []Gutters/Covers❑Entry Doors Q_ Alirduaurn2S�Y DelmnitofCon nu1Amountdueuponexecutitn ofIII coalraatH. Total Contract Amount $ AladnePuralutwmnutrnotda witnwrethanane-third of the ContractAmornt. U Customer agrees that,immediately uptr%„}ca014p stMrl of tine work for each ProductCustomer will execute a Completion Certificate (one for each Product as defined by an tndividual ` s^titre4,1�,creunvler.' nd Ia ay my tr tl antis due f yip i) rials, 4 1t,C uswrtner under this Contract agrees to be,jointly and severally c�btigat` )T"hc}Ioarno Depot reserves the right to issuea Change Orderfnninate this Contract or army individual Product('s)included herein.at its discretion,if The Home Depot or its authorized service pnlvu)er determines that it cannot peri'orm its obligations due to a structural problem will)the home,environmental hazards such as mala,asbestos or lead Print,other safety concerns,pricing errors or because work rcrluired to complete tine job was not included in the Contract. , (� included as part of this Contract, wets forth tire,total "++t l untrmarv^ The Payment Summary#�aotl rrnaraR oolquraky�� r:,yments rewired for the depayments by Product(as applicable), NOTICE TO CUSTOMER You are entitled,to a cumlriuiily'fijled-ut cagy of Ute Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product Is complete. ill In Ute event of terntinution of this Contract,Customer 01grecs to pay The Home Depot the costs of materials,labor,expanses and services provided by'fIre Horne Depot or Audntrized Service Provider through the date of termination,plus amy other amounts set forth in this A rrectment or allowed under appliable taw. T'IIh,HC)i4I1 DlslrO'r MAY 1V1'CIIHOLD \hIOI"NTS O1v1;I) 'I'D 'I'llh IIOMI?kDl�.PO'I' lrltoM 'l'Hh". Dl',POSIT PAYMENT OR O'l'lllrlt PAYMENTS MAl)h, 11'N'T'IlOU1" 1,.111TI'1TNG'rTH;HOMIs DI'PO'1"S O'1'TIT R RIs 1 DIIS FOR RECOVERY OF SUCH AMOUN'T'S. Ace mance surd Authorization: Customer agree.l.m(1 understands[hat this Agreement is tine entire Agrechncut between Customer ant "l'ac home Depot will,regard Io the Products anti Installation services nand supersulcs all briar ah.catssinnsaantl,t�tcetmetits,either Oral or written,relduing to said Products and Installutia ir,This Agreement cannot be assigned or amurdcd except ba,'a rxrititng wiLnud by Customer and T"Ire florae I)apaat,C;ustouaer aia an e iges and agrees that Customer has read,understands,voluntarily accelus the tcrnns of and has recciv •opy of this Agreement. A(cee> v. /�.j�p/�/+']� Submitted by: X .�............. .....m........ .....p ! V�y 4 Yom- -.a.. !1 ............. Signature ... ....._.........�, Custinne sSigouure Cale SalesConsultu sSignature �ry Dalt*j� 3s _ _ 1 Telephone No, Customer's s Signattire Date ,Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEI, ,1"HIS aasap rcablck AGRP;FAIENT WITHOUT"PENALTY OR OlHX;AVON BY DE?LIVERiNC, WRIrrh",N NOTICE TO'I'Hl,; ............ Th C(I Ofjle 0 of f n Ves tig,(16 0 m; I Congress Strwt,Suite I W) Bost^ M4 02114-244'.' www.mass.Uov/dia -a3,Iraae- Affidavit: Worken' C-)mpeuiadoa rctriciansfPfunzbers please Y1 �P-�� Ile, '015*'> Phone g: A or? Check the Opropriate box: Type of project(requiredy. ,-re you JH eMPIO'Y project 4, 1 M a gmeral contractor and 1 6, C]New cousirl-IctiUn I=a employer with 13 .o have hired the sub-uoutractor3 employees (full and/or part-time), 7, ❑Remodeling Listed on the attached sheet, I am a;ole proprietor or partner- These sub-contractors hav,. g, Demolition 313iP and have no employees employees and have workers' working for me in any capacity. 9. Building addition ii comp, �nce.t Electrical r-.Pair3 Or iddition-q bio woric-.rg' 3OMP, b=a1ar-' 5, 7 Wa 3T-.a corporation and its 10 11"F L)fflicer3 ha-q,,-excroised thoir Plumbing r,IM I laomeo riot olfax--Mption per L\'IGL M:,Iqe L fo worl,,fr i' mrap L(4),andwo huxm no =Ploy-.es. D"o Woricarg, 13- rhar COMP. 11LIMXRco mquired.] i•sn tae±e6-,jq)c.4 nust 31so Ell nut the'idcdca 7clOq showing thc'r-NofIc"'comper's a on t Ho I Mei.),WT[tr- y[io iubmitfts iffidavit iadiCating LhIY ff-iOing 1J1 Work orbowingk Md dimbireoutside ched m latiallal 3he c,Dflwactors-Lhilt zheck his box ulust Itm 'el Le aame..3fho mb-cDutrntars 3ad;tato Adher Or(Lot Use zntities hwn E -ub ­007ces,they must provide their worscn'comp.pollcY Limb- ftMPI s, if the, -conaaaars�avf, a paltry and jot Me f am an employer that is praWdinIq workery'compensation insvivicefOr MY en'PlOyffes- ,below is 1h information. Lhs-ora=- Company Name: V. on tA Expiration Date: Policy#or Self-ins.Lic. 9: City/State/Zip: Job Site Address: ach a copy oj the vvorkargcompensation declaration page (showing the policy number and expLration date). Ik tt required under Section 25A oNvIOL c, 152 can lead to the imposition of criminal penalties Of a Failure to secure coverage as Nqu ane as well as civil penalties in the form of a STOP WORK ORDER and a find .up to$I,soo,00 and/or one-year imprisonment, 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, the information rmadon provided above is true and correct I do her ce W d 41 es ofpedu th Date-, Phone 4: offletal use only. Do not write to this area, to be completed by city or town off WA City or Town: permitfLicense A. Issuing Nathority(circle o*' 1. Board of Ueflith 2.BuildingDepartment 3.City/Town Clerk 4. Electrical InsPectOr S.plumbing inspector 6, Other Phone 0., Contact Person; CERTIFICATE OF LIABILITY INSURANCE D0212412o 6gmrYY) 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 HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 1S 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). PRODUCER CONTACT MARSH USA,INC. NAME: PAX TWO ALLIANCE CENTER PHC N n E No: 3560 LENOX ROAD,SUITE 24W E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 100492-Home0-GAW-16-17 INSURER A:Steadfast Insurance Company 26387 INSURED THE HOME DEPOT,INC. INSURER g.,Zurich A€ne6can Insurance Co 16535 HOME DEPOT U.S.A.,INC. INSURER C:New Hampshire Ins Cu 23841 2455 PACES FERRY ROAD,NWlNsuRER D:Illinois Nallonal Insurance Company 23817 BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003741310-08 REVISION NUMBER:O 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. )NSR TYPE OF INSURANCE ADDL S BR POLICY EFF POLICY EXP POLICYNUMBER MMIDDNYYYJ (MMfDD1YYYYJ LIMITS A X COMMERCIAL GENERAL LIABILITY GL04887714-06 03/01/2016 03101/2017 EACH OCCURRENCE S 9,000,000 RETED CLAWS-MADE FqOCCUR PREM SESOEa occu rrence s - 1.000 000 LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED OF SIR:$IM PER OCC PERSONAL&AUV INJURY $ I 9,000.0D0 GENT AGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE S 9,000,000 X POLICY❑PACOLOCO- PRODUCTS-COMPIOP AGG S 9,WD,000 OTHER: 5 B AUTOMOBILE LIABILITY BAP 293886343 0310112016 0310112017 COMBINE=D SINGLE LIMIT accide1,000,000 Ea nt X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED, SELF INSURED AUTO PHY DMG BODILY INJURY Per accident) S AUTOS AUTOS HIR ER AUTOS NON-OWNED PROPERTYDAMAGE 5 AUTOS per cdent 5 UMBRELLA LIAR H OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED I N S S C WORKERS COMPENSATION WC0155192%(AOS) 03/0112016 03101/2017 X I PER OTH- C AND EMPLOYERS'LIASILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVEWC015519217(AK,KY,NH,NJ,VT) 03!01!2016 03/01/2017 D OFFICERIMEMBEREXCLUDED7 F_N_1 NIA E L EACH ACCIDENT 5 1,000,000 (Mandatory in NH) WCOIS519216(FL) 03101f2016 03/0112017 E.L.DISEASE-EA EMPLOYEE S 1,000,000 It yes,describe under Continued on Adrk[ional pa e DESCRIPTION OF OPERATIONS below 9 F.L.DISEASE-POLICY LIMIT S 1,000,000 T' . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD illi,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16000SGOODST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhodee _.1w1L_M%A_roc.;. _N,,Q,�sa t,r ©1988-2014 ACORD CORPORATION, Ail rights resealed. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ci Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement,:',Contractor Registration Registration: 126893 .: Type: Supplement Card Expiration: 813!2018 THD AT HOME SERVICES, INC. RICHARD FALLONE 2455 PACES FERRY ROAD, HSC G=,1`1_ . _ _ ATLANTA, GA 30339 Update Address and return card.Mark reason for change. Address 1 Renewal Employment i Last Card 3011 _ nice of Consumer Affairs&Business Regulation License or registration valid for individual use only i ' '� OME IMPROVEMENT CONTRACTOR before the expiration date. IP found return to: Office of Consumer Affairs and Business Regulation Registration 126gg3 Type: 10 Park Plaza-Suite 5170 Expiry#foSupplement Card Bostonj.MA 021-16 THD AT HOME SERVECES;'I! THE HOME DEPOT:ATGf9M-[0 RVICES RICHARD FALLONE 2455 PACES FERRY ROAO HSC - ATVANTA,GA 30339 Undersecretary of valid with t si ature boar�j OX BUIlding Regulations and Standards. t-Icense , CS-081726 a m S r e . . ,_ ivr . 91 .. TYLER ROADa TEWKSBURY MA a; pi rat Y 06/10/2018 Scanned by CarnScanner