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Home My WebLink AboutBuilding Permit # 9/26/2016 r%0 RTF( BUILDING PERMIT TOWN OF NORTH ANDOVER _ APPLICATION FOR PLAN EXAMINATION At _ Permit No#: Date Received ��$�RATE° SACH335 Date Issued: �� PORTANT: Applicant must complete all items on this page LOCATION a Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: C ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid al Non- Residential L] New Building fllbne family L]Addition ❑ Two or more family Li Industrial ❑Al -ration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: D Demolition ❑ Other ❑ Sept►c ❑WeI1 n Floodpla�n is❑'W et[ands ❑ WatershedDs tr t DESCRIPTIQ.N.9� WO K BEP -RFORMED: P tification- Please Type or Print Clearly OWNER: Name: Phone: Address: rz) A._LL Contractor Name: _ Phone: t Email: Address: Supervisor's Construction License: Exp. Date:—415t Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;SULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access the guaranty fund . ....... .................................... ... ... . OORTNy Town of F 6 over No. a h ver, Mass, e � S U BOARD OF HEALTH PER T 0 Food/Kitchen Septic System THIS CERTIFIES THAT ...............�...� BUILDING INSPECTOR ... .. .. ............................................................ a has permission to erect ......... buildings on Foundation ................. .....,...... ........... ,....`..�.r... '. ..,.... . to be occupied as ..................... Rough ........... ......wtv ........Rq' . , Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITXI IN ELECTRICAL INSPECTOR UNLESSC GTI A Rough ............. /. Service ........... BUILDING INSPECTOR..SPECTOR Final GAS INSPECTOR ®ccu unc Permit Required t® OccupE Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Mall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the wilding Inspector. Burner Street No. Smoke Det. ......... ......... ......_.. _........................._.......... A EY CERTIFICATE OF LIABILITYINSURANCE 02t24 o sD1YlYYI 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, E=XTEND 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 SU13ROGATION 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). PRODUCER CONTACT MARSH USA,INC. NAME: FAX PHO ALLIANCE CENTER AlON o Ext. AIC No): 3560 LENOX ROAD,SUITE 2400 F-MAIL ATLANTA,GA 30326 ADORESS: INSURER(S)AFFORDING COVERAGE NA€C M 100492-HemeD-GAW'-16-17 INSURER A:Sleadfast Insurance Company 26387 INSURED INSURER B-.Zurich American Inswance Co 16535 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C:Nety Hampshire Ins Co 23841 2455 PAGES PERRY ROAD,NWINSURER D:Illinois National Insufance Company 23817 BUILpING%-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: A71--0037413J0-08 REVISION NUMBER:D THIS 1S 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. INSRTYPE OF INSURANCE ADDL 5U2R POLICY SFF POLICY EXP LTR LTR POLICY NUMBER MMIODIYYYY MMIDDNYYY A X COMMERCIAL GENERAL LIABILITY GLO4887714-06 0310112016 0310112017 EACH OCCURRENVE 5 9,000,000 DAMAGE TO RENTED 5 1,000,000 CLAIMS-MADE [X] OCCURPREMISES Ea occurrence LIMITS OF POLICY XS MED EXP(Any one Prison) S EXCLUDED OF SIR:SIM PER OCC PERSONAL&ADV€NJURY S 9.01,000 B GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 9,000,000 D POLICY❑ PRO. r LOG PRODUCTS-COMPIOPAGG S 9,000,0110 X JEC7 OTHER: 5 I B AUTOMOBILE LIABILITY BAP 293886313 03101!2018 03!0112017 COMaINED sINGLe LIMIT ; 1.000,000 Ea accident X AI4Y AUTO 13001LY INJURY(Per person) S ALL OWNED SCHEDULE=D SELF INSURED AUTO PHY{IMG BODILY INJURY(Per accident) S AUTOS AUTOS ° NON-OWNED - PROPERTY DAMAGE S HIRED AUTOS AUTOS Per acciden S Uh16RELLA LIAR OCCUR EACH OCCURRENCE 5 r EXCESS LIAR CLAIMS-MADE AGGREGATE 5 DED RETENTIONS S C WORKERS COMPENSATION WG01551926(AOS) 03101/2016 03101017 X STATUTE ERH ` AND EMPLOYERSLIABILITY p G YIN WC015519217 AK,KY,NH,NJ,V 0310112016 03!0112017 1,ODD,000 S ANY PROPRIETORIPARTNERIE E� CUTIVE ( T1 E.L.EACH ACCIDENT S D OFFICERIMEMBEREXCLUDED? N NIA 1MandatoyInNH) WCD1551921"o(FL) 03fD1l201fi 0310112017 E.L.DISEASF-EA EMPLOYE S 1,000,000 If yes,describe under Corl6nlletl Dn Addi6vna!Pa1,DDO,ODO DESCRIPTION OF OPERATIONS below De E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCAT€ONS I VEHICLES (ACORD 1011,Add€ttonal Remarks Schedule,may he attached If more space is required) CERTIFICA I E HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 160005GDOD5T. 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 Mukhegee S ��1 u-� �,tJ•d r+ is 0198$-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I 3 � -. ..ii .r rbJnna�i/,:;.r:�•y,b.:l.LJ3 lil ,l Y„�y4.317 w.,,.ae.vu ti-hr.r.. Office of nvestigadons 600 Washington Street Boston, MA 02111 d wwlv>mass.govIdia Workers' �Co..mpensadon 113sur-anec A ffidavi�: B�zzldexslCf��rae�aa-sl�Ie�txicia�s/��m�i��rs Applicant Infox•-Matfox;t Please Pxia�t Le Bbl Name (Business/organizatior4ndividual)' � y 1 Address:" City/State/Zap: , % -R ne#: a a Are you an employer? Check the appropriate b : Type of project(required): 1.❑ I am a employer with 4. Rr 1 am a general contractor and I 6. C]New-construction employees (fall and/or part-time).* have hired the sub-contractors 2.C1 I am a sole proprietor or partner- listed on the attached sheet. # 7• El Remodeling u ship and have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers' comp.insurance. g• ❑Building addition I° [No workers' comp.insurance S. ❑ We are a corporation and its required./ officers have exercised their l0 ❑Electrical repairs or additions right of exemption per MGL 11.❑plumbing repairs or additions j �.❑ I am a homeowner doing all work g p p myself. [No workers' comp. c. 152, §1(4),and we have aro 12Rgpf repairs insurance required.] t employees. [No workers' 13.9/Other AA 101,04& Copp.insurance required.] Iny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 3 Homeowrim who submit this affidavit indicating they are doing•alI work and then hire outside contractors mustsubrait anew affidavit indicating such. _. :ontractors that cheat Phis box must attached an additional sheet showing the name of the subcontractors and their workers'camp.policy infomtation. am an employer that isproviding workers'cornperrsation insurance for my employees. Below is thepolicy acrd job site formation. suraa-ice Company Name: - r elicy#or Self-ins. Lic.#: l w Expiration Date: ` z b Site Address:_ City/State/Zip: - :tach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). n ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a p e up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDERand a fine up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of testigations of the DIA for insurance coverage verification. o hereby ce/r(( if nd r th pants anal penalties of perjury that the information provided above is true add correct nature: Date. }� —• ane#: Official use only. Do not write in this area, to be completed by city or town offaciaL City or Tovvri- Permit/License# [&suing Authority (circle one): t.Board of Health 2e Building Department 3.City/Town Clerk 4.Electrical Inspector 5>Plumbing Inspector . i.Other -ontact Person: Phone#: ` I i. e. Regulation offic Affairs and Business Re q 'e Of CC)nsumer to Park Plaza - Suite 5170 setts 02116 Boston, achu Home lmprovemURegistration CContractot a� Req 126893 Suppiernent card SIT201 8 Expiration. ICES, INC. E SERV THD AT HOME -- RICHARD FALLONS 2455 PACES FERRY ROAD, HSC ATLANTA, GA 30339 and return card.mark reason for change. up te address — Lost Card da zMpioyment — Renewal address License or registration valid for individual use on17 9 13usiness Regalatio" before the expiration date. If found return to: Consumer Affair Affairs and Business Regulation {{ice o TRACTOR Office of consumer Afra ENT CON MF ME 0 Lo Park -Suite.5170 _IMpROVE Plaza Type. Z.; iN W 6- NL I supplementGard- ME Tt,jo AT HO W� ICES THE HOME DEPOT RICHARD FALLONE fdk 4t)t valid with t turere 7455 PACES FERRY R-rVANTA,GA 30339 tTuders"rewrY i I ensee Details Liemographic Information Full Name: SHAWN M LEI�IAY jp�fioer Name, resp Information City: Danville State: NH Zipcode: 03819 �oijntm LJ 'ted tates License r a ion License No: CS-069270 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 7/7/2016 Issue Date: Expiration Date: 8/17/2018 License Status: Active Today's Date: 8/31/2016 Secondary License Type: Doing Business As: atus Change R as n: License Renewal Prerequisite r ion No Prerequisite Information CloseVindow ; 3 20 11 Corr)rnonweaith of Nlassachusetts Site Policles Contact U3 hlip?!el icens e.ci�s.state.m a.usr�'eri fi rali on]D elai Is.as p0agency-id=I U cense_id=258220& 111 Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126894 Salesperson Name and Registration Number: Leonard Racite : R-1-073-14-00023 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Ramon Suero 9529671 -First Name Last Name Branch Name Lead# 8 Walker Rd Bldg 8 Unit 6 NORTH ANDOVER MA 101845 Customer Address city State Zip 1(978) 975-1619 978) 360-3026 Home Phone# Work Phoneff Cell Phone# santoramon65@gmaii.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES `Pr!,-J.AT THIE- 000,141TRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNGItAILEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE 10F YOUR RIGHT TO CANCEL. Acknowledged Ii,, x09/01/2016 Customer's Signature Date Distribution: White- Home Depot Yellow- Customer Copy __ ... ......_ ________ __ _ _ _ WINDOW SPECIFICATION SHEET - Spec.Sheet#; 9529671 Sheet; 1 m i Customer: n*m^^ouem Jou#: wse96n1 Consultant: Leonard Rawte Date: 09101u2016 _____ NewWindow Hinge Location's Existing Window Measurements Grids Product OpUons Labor Options From OLI Left to Right Bays,Bowls Location Color Rough Opening of bars #of bars Csinnts,I PnI, Glass Mise Items Hardware Code Screen For doors use Mull S"=statonary or 'X" operating Style Wraps z- Code (YIN) Style Code Series Code > > x FIT HT KT SPECIAL CONSIDERATIONS: Interior Casing Type Bay or Bow window: 3eatboard material(vinyl only-Birch or Oak) 3ay Project Angle(30 or 45) aay Flanker Type(DH,SH,or Csmnt) Top ofwindow to soffit(Inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the -onstruot Roof(Yes or No) Sperral Terms and Conditions on the following page Garden Window: Seatboard Material(vinyl only-White Pionite.Birch or Oak) Wall Thickness Onches) Customer Signature 4dditional Shelf(Yes or No) 'There is no guarantee that new shingles will match existing color.