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HomeMy WebLinkAboutBuilding Permit # 9/26/2016 JAORT! BUILDING PERMIT 01�YLEP 'a;°�o TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION xT ey r Date Received qo LniED Permit No#• - �" f A,rEP� •c �SSACH►15�� Date issued: PORTANT: Applicant must com lets all itezx�s on this page LOCATION _ Print PROPERTY OWNER � i0c� Print 100 Year Structure yes no MAP ® PARCEL: ZONING DISTRICT- Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOS USE Resi tial Non- Residential D New Building One family D iepEacernent ❑ Two or more family ❑ Industrial ❑ No. of units: ❑ Commercial ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑We11 ❑ Floodp[air ❑Wetlands ❑ Watershetl pstnct ❑UVaterlSewert .. z. DESCRIPTION OF WORK TO BE PERFORMED: Tdentifi tion- Please Type or Print Clearly OWNER- Name: Phone: Address: ( 4 Contractor Name: Phone: qu Email: Address: Oj Supervisor's Construction License: `Exp. Date.—_-4/ Home Improvement License: Exp. Date: ARCH ITECTIENGI NEER 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- $ FEE: $ Check No.: �, ;77 _Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces o the uaranty fund �ORT� '4 oven of 2 a � Andover No. 3 — 0 i , h ver, Mass, • �p CCC MIC HCw,C II ' RTEO U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect .......................... buildings on .........�.. ..... .+l �M. '1 Foundation Rough tobe occupied as ...................................10.........W.I... .. ...5..................................... 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 �+ MONTHS Final y� PERMIT EXPIRES l 6 ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOSTART Rough ............. . ...� . . Service ................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Rough " Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wali To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Home Depot Contractor License Numbers: MA Home Improvement Contractor Req. # 126894 Salesperson Name and Registration Number: Richard 0 Donnell : R-1-073-13-00064 Home Improvement Agreement The Home Depot ("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: _ robert bertolino E9:421534 First Name Last Name Branch Name Lead # 10 deer low rd NORTH ANDOVER101845 Customer Address City State Zip 1(617) 794-1727 Home Phone# Work Phone# Cell Phone# richard-odonneVl@homedepot.com Customer E-mail Address NOTICE OFR G HT 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 or Email C u stome IrCancel I ation North East(a),homed epot.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 THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by,. X 08/26/2016 customer's S1 Date Contract Price and Payment Schedule: Payment of the Contract Price is due upon completion unless a different payment schedule is specified in the State Supplement. Includes all applicable discounts, rebates, and , taxes. Contract Price $ 4728.00 Excludes finance charges.* Minimum %deposit$ Due Immediately Remaining balance $ Due upon completion .......... ............. ...... WINDOW SPECIFICATION SHEET - Spec.Sheet#: 9421534 Sheet: 1 Of 2 Customer: robert bertolino Job#: 9421534 Consultant: Richard 0 Donnell Date: 08/26/2016 New Window Hinge Locations Existing Window Measurements Circle Product Options Labor Options From outside. Left to Right Bays.E30WIS Location Color Rough Opening #of bars 4 of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use 5 to Mull 'S"=stationary or LL X'—operating 7i Style Wraps 7i;i "ru nr� Floor Code We Code Series Code U V_ > Roo (YIN) T:, . STD,GiassPack:Standard 1 PCRCH 1st DH N DH 1200 W vV 30.00 5400 84 STA.GlaSsPaGk'Standard 2 PORCH IS1 CH N DH 1200 VV VV 00.00 54L00 84 STD,G[AssPack:Standard S PORCH 1st OH N DH 1200 VV w 30.00 54.00 84 STD.GlassPacK:Standard 4 PORCH 1st OK N DH 1200 W W 30o0 54.00 114 STD.GlassPwk:Standard 5 PORCH 1st DH N DH 1200 IN VV 30.00 54.00 104 6 PORCH I,. IDH N 1 1). W Moo --co 84 1 1 SID,G1.as,Pa,l.Standard STD,Gl­P..k:Standard 7 1`01'kCH 1st DH N DH 1200 W W 30.00 54.00 84 STB,GlassftcX:Standard a PORCH 1.t DH N OH 1200 W IN 30.00 54.00 $47 SPECIAL CONSIDERATIONS: Nrap Color nter[or Casing Type Bay or Bow window: Seatboa,rd material(vinyl only-Birch or Oak) ay Project Angle(30 or 45) 3ay Flanker Type(DH,SH.or Csmnt) Top of window to soffit(inches) f bed to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the �onstruct Roof(Yes or No)- I Special Terms and Conditions on the following page Garden Window: r,.lboafd Material{vinyl only-White Pionile,Birch or Oak) al Thickness(inches) Customer Signature dilional Shelf(Yes or NoI There is no guarantee that new shingles will match existing cobr, ........... WINDOW SPECIFICATION SHEET - Spec.Sheet#: 9421534 Sheet: 2 of 2 Customer: robert bertollno Job#; 9421534 Consultant: Richard 0 Donnell Date: 08/26/2016 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to RIght Bays,Bowls Location Color Rough Opening #of bars #of bars Csronts,1 Pri. use L.R or 8 Glass Misc items Hardware Code Screens For doors use Mull "S'=stationary or .2 "1 operating M 2 Z Style Wraps 31 0 Room Floor Code (YIN) Style Code Series Code 'E LL 5 i2t L6 0 a, > 1: > STD,Glass Pack:Standard 1st DH N DH 12DO W w 30.00 54.00 84F.— I I I I I I I STD,TMP 7 Full. 1 LIV 1st PW N PW 1299 VV I- -..e 60.00 126 r...Ci -HI.W c ALL 6 4 ALL 5 4 GI_P.ck:Standard HT SPECIAL CONSIDERATIONS: Nrap Color nterior Casing Type Bay or Bow window: 3ealboard material(vinyl only-Birch or Oak) 3ay Project Angle(30 or 45) �ay Ranker Type(13H,SH,or Csmnt) Top of window to soffit(Inches) I have reviewed and agree with all the job specifications above arid the f tied to soffit,color of soffit material onstrudt Roof(Yes or No]' i Special Terms and Conditions on the following page Garden Window: Sealboard Material(vinyl only-White Pionile,BIrch or Oak) VVWl Thickness(inches) Customer Signature Additional Shelf(Yes or No) -There is no guarantee that new shingles will match existing color, vJ 'EVA _De, partmentofInd.ustrial Accidents Office of Investigations I iv www.nzas&gov1dia 600 Washing-ton Street Boston,KA 02111 Workers' Compensatio-n Insurance Affida-vit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LIgibly NaTne 7'A:ddVb'=­ City/State,/Zip: LAI--, hone# Are you an employer? Check the appropriate bg-x'. Type of project(required): 1.❑ 1 am a employer with 4. Rr I am a general contractor and 1 6. New construction employees (full and/or part-time)."' have hired the sub-contractors 7. ❑Remodeling 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capapity. workers comp.insurance. 9. ElBuilding addition 5. El We are a corporation and its [No workers' comp.insurance 10.EJ Electrical repairs or additions required./ officers have exercised their j. ILE]Plumbing repairs or additions right of exemption per MGL 0 1 am a homeowner doing all work 9 myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑' 13. Other�airs insurance required.] employees. [No workers711 oTp.insurance required.] 1ny applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing•all work and then hire outside contractors xnust subrift anew affidavit indicating such. ontractors at check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my eniploy'ees. Below is the policy and job site surance C any Name: omp 22— i2 V )]icy#or Self-ins.Lic.#: Expiration Date- City/State/Zip: b Site Address: t Inch a copy of the workers' compensation policy declaration page(showing he policy number and expiration date). f lure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penaKes of a e up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WO R.K ORDERandafine up to$250.00 a day against the violator. Be advised that a copy of this statement may be ibrwarded to the OfficC of iestigations of the DIA for insurance coverage verification. o hereby cer i nd r th pains andpenalties ofperfurythat the information provided above is truaidcorred, Date* )ne ff: Officia[use only. Do not Write in this area, to be completed by city or town offl-CML Permit/License City or ToWii: Issuing Authority (circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 5. Other �ontact Person: Phone# i CERTIFICATE OF LIABILITY INSURANCE Do2rz4rzo�tsD1YYYY) �-� THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO EIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENIA, EXTENT] OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS.CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), 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 tenns 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: PHONE FRX TWO ALLIANCE CENTER Wr.No.Ext• A1C No): 3560 LENOX ROAD,SUITE 2400 nDDRIEss: ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC# 100482-H9meD,GAW'-16-17 INSURER A:Steadfast Insurance Company 26387 INSURED INSURER M_Zud-b American Insurance Co 16535 THE HOME DEPOT,INC. HOME DEPOT U.S,A„INC. INSURER C.New Hampshire€Bs Co 73541 2455 PACES FERRY ROAD,NW INSURER D:Illinois Nafmnal Insurarim Company 23617 i elssLnlN�c-zo ATLANTA,GA 30339 INSURER fs: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003741910-08 REVISION NUMBER*0 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 CER'OFICATF 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 MA16,HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OF INSURANCE AODi SUER PDL€CY NUMBER MM1DDl>YYY NPM �A XP LIMITS A X COMMERCIAL GENERAL LIABILITY GL04887714-06 0910172016 03/0112017 EACH OCCURRENCE 5 9,000,000 CLAIM&MADE OCCUR PREMI ETORENTED DAMAGEEaocuttence 5 1,000,000 LIMITS OF POLICY XS MED EXP(Anyone person} g EXCLUDED OFSIR:S1MPER000 PERSONAL&ADV INJt1RY $ %OW'000 GEN'L AGGREGATE LlMITgPPLIES PER: GENERAL AGGREGATE S 9,000,000 X POLICY Ll ET D LOCPRODUCTS-COMPlDPAGG 5 9,O W,000 OTHER: 5 B AUTOMOBILE LIABILITY BAP 293886313 0310112016 0310112017 COMEaacddenS BINED SINGLE LfM1T 5 1,000,000 X ANY AUTO BODILY INJURY(Per person) S glLowNSD SCHEDULED SELF INSURED AUTO PHYDM6 BODILY INJURY(Per accident) s AUTOS AUTOS HIREDAUTOS NON OWNED PROPERTY DAMAGE S AUTOS Per accident S UMBRELLA LfAf3 OCCUR EACH OCCURRENCE S EXCESS LfAB CLAIMS-MADE AGGREGATE S DED R NTIONS $ C WORKERS COMPENSATION WC015519215(AOS} 03101/2016 03101/2017 )( PER OTH- C AND EMPLOYERS!LIABILITY STATUTE ER ANY PROPRIETORIPARTNER/1rXEGUTIVE YIN WC0155192V(AK,KY,NH,NJ,VT) 03101/2016 03/01/2017 1,000,000 OFFfCERlMEMBER EXCLUDED? N N/A EL EACH ACCIDENT b D {Mandatory In NH} WC015519216(FL) 03101/2016 0310112017 E.L.DISEASE-EA EMPLOYEE S 1,000,900 It yes,describe under Continuetl an AdManal Pae 1.000,000 DESCRIPTION OF OPERATIONS below Il E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS LOCATIONS 1 VEHICLES[ACORD 101,Additional Remarks Schedule,may he attached it more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600OSGOODST THE EXPIRATION DATE THEREOF, NOTICE MILL 132 DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. ManashiMukhedse Lnr,i=ara4: �3 c ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26{2014101} The ACORD name and logo are registered marks of ACORD i I e 64/N? Regulation Offic e of Consumer Affairs and Business 1�e 10 Park Plaza - Suite 517a t02116 tN/j?tssac;hLUset_s Boston, Home Imp rovem-6a0ntractor Registration x, � Registration: 126893 r- Tyke: Supplement card E iration. 802018 ME SERVICES, INC, THD AT H01 RICHARD FALLONE ACES FERRY R0 A D, HSC 2455 P d.Njark reason for change ATLANTA, GA 30339 Address and return card. nt Lost Card zmptoyine xddress tion valid for individual use Gull gistra e or re License date. If found return to: ffice of Coasamer.Affairs Business Regulati'a 10 expiration before t] Affairs and Business Regulation Consumer Afra- -TRACroR (>Tace.0 OME IMPROVE ENT CON 5170 --M... Type.� 10 park Plaza-Suite. lstratgiRegGard- Boston, V uGP E 0 ) -A THD AT H01ME SERV{_`[ER'10CES THE HOME DEPO RICHARD FALLOIF—, valid with t 3i tore re 2455 pACES FERRY undersecretary RTVANTA,GA 30339 °f i$ BENJAMIN PAR :, 43 C-AZEENOUGH Plakfavv NI-1 03865 02111 /2018 .. . 4