HomeMy WebLinkAboutBuilding Permit # 10/25/2016 BUILDING PERMIT pFQ oT 6 q1
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIONI Al
Permit No#: — Date Received �o may°
��SsacHus��ty
Date issued: , 0 O
IMPORTANT: Applicant must complete all items on this page
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PROPERTY OWNER <: 4
PnnfODYearSfrucfure yes no
MAP PARCEL. BONING DISTRICT
Historic'
�stnct ye no :'
Machine St op I age Y s::o no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New ding ❑ One family
❑Ad ' ion ❑ Two or more family ❑ Industrial
❑ teration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑1111e11 ❑ Floodplain Wetlands ❑ Vvatershed District
❑SlvaterlSewer
DESCRIPTION OF WORK TO BE PERFORMED:
�•'o �rx� X
Id ntiffcation- Please Type or Print Clearly
OWNER: Name: �� k v«C Phone:
Address: 5 Foarr wo 0
Contractor Name: l I�AK a.+^k rc / Phone: l t
Errnal.
1`07 -
Supervisor's Construction Leens Exp Date ,
Home Impra�em'ent License_ - Exp Date - 4 t'
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE'SCHEDULE:BULDINO PERMIT:$12.00 PER$1000.00 OF THE TOTAL.ESTIMATED COST BASED ON$125.00 PER S.,F
Total Project Cost: $ �� 3 _` __.....__.—FEE: $
Check No-: Receipt No.:
��.
DOTE: Persons ntra&ing with unregistered contractor o not have access to th guaranty fund
;signature o Agee Owner S nature ofi contractor
IAORTH
Town of 4 _ 6Andover
0
No.
ver, Mass, ZA, M1 to
COCM[CftEWKK yR.
ATE D 00"r
S U
BOARD OF HEALTH
Food/Kitchen
PERMI T T LD♦ TT Septic System
THIS CERTIFIES THAT .. 14... . .. .. . ..... ..�+� .l.• l.. ..... . BUILDING INSPECTOR
Foundation
has has permission to erect.......................... buildings on . ... . ,... .:. . .0D0.....l�N .....1.
. .
Rough
to beo114�IA&..."A.- ..PAT��.. ........................ Chimney ney
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 6THS ELECTRICAL INSPECTOR .
WA6500
UNLESS CONS Tl® Rough
Service
Final
BUILDING INSPE R
GASINSPECTOR
®ccupaucF Permit Required t® Occupy By 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.
�pr
Home Depot Contractor License Numbers:
MA Home Improvement Contractor Reg. # 126893
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: -
Bill Roebuck 16601247
First Name -Last Name Branch Name Lead#
25 Farrwood I [iTORTH ANDOVER MA 01845
Cusiomer Address City tate zip
�(978) 258-1618
Home Phoneil Work Phone# Coll Phone#
leonard_s_racite@homedepot.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 B)(,' HOME
DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME
CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED 1,0 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:
09/28/2016
X Customer's Signature Date
Distribution: White -Home Depot Yellow-Customer Copy
Simonton Windows
6500 VantagePointe
a Double-HUn Vint'i- 118"Glass Argon•Lovj--E'No Laminated Glass
9 ! g
With Grids
..
lraii•�r, Ventzna de doblc gtniiiotina•Vinito•3.1$mm Video•Argdn'Losr�-E'Sin
Rarpt c lrr vidro laminado•Con rejillas
CPD:SBP-A-44-21042-00002 07-75 DH
ENERGY PERFORMANCE RATINGS
EVALUACION DE RENDIMIENTO ENERGETICO
U-Factor 1 Solar Heat Gain Coeffclent
_'ZCIGf•'v 0O6b1:F"!4.GEriarpla cw=rer�is Sri:Lr
0.29 1 .65 0.24
ADDITIONAL PERFORMANCE RATINGS
EVALUACION SUPLEMENTARIA DE RENDIMIENTO
Visible Transmittance i
T;1W.Vr,mo.OR'42`;SiGla
0.45
Mar,G.z:urer:tpa:?lesaata.Qseraf ounfortn:cayp'pah!4'Sqe,pr.r-e ur-:or4a!5rr:ing'rhafeprod l?alxrarca.NFRG.ategsara
aetor .".e eeabcadsetofiriv'uomea!a.aonaao.2sarAa c'z? e}:ts'�a.:. (sCdaa3:otr;or,menaaryarodactandJos no!warant'se
sudrA_?r orany?rnr'ua.'.x arylgri`.a:�a,Corsu�;:raaufa:h�rara::;,;3'arB(cr a..9:prod�n;E pefrrar,:e tntormaEcr�.•;,rss.afrc,arg
�s:e fsbxada FsSnuta eue va!o-es curoc:an car;los pr n,miectos a?.n[n as.3`RC pa,a dawrhiror a ro di;rt6n?•:Val Jai oroducto.=os valcrrs
use 3,3 i)vv=RCson por kr.�oniun;o yo c: co rx-iw632f.';.ieri3:eS J'Uf 13c;9:'.0 de pnLclm espec& .NiFRC no riper,€endo
'Lqun or..aa:I y no pranfta h:;e a1 Cr,,ru:tsea a7acuvo p5:a un Ao Corrina:on al fo,telo lai'abr,CEnta pa"n ei v6 a?rJaiadd da
eale pr ad;.cr wux Mrc oro
;w
KIM
ij li>' �'•• Ji F-
s�,. Unit qualifies for ENERGY
STAR(9)reg€on(s):Northern,
North Central,South Central,
Southern.
-�
�'' ' x
x�• F �j
,r, STC:29
G�r;etfi,�€
i+�5 fw� IND:Rein 001Glass ProSolar/H-LC25
•J1 Tested Size:48"x 80"
Florida ProductApprovai:FL5167
Applicable Test Standard(s): ANSI/AAMAINVMDA 101/1.8.2-97,AAMAANDMA/CSA
1011€.S.21A440-05,AAMA/WDMAICSA 90111.5-2/A440-08,
r r A440S1-09 Canadian Suppl
F
8858790101 x,0333 HIS Howard 6400094A
Ke?pnsaL•?isurOS5,GdENERGYuT�-e:,ata ;G!exr,more`i :4vxene,�jy5:argov.
GU17Z]e es;a etq:leia sosb!as reemz->>:srs EN ERG!STAR.Agra co7,r er.T.ds aGc�a de!esl.;,vosife w kw.ewo ysiar pv.
t ;
T11e C01n1110nvealtlt of Massachusetts
Deperrf;nietst of Ifldrastrirxlflccidents
17- " f. Office of In-�estiaatioru
.1 Colt,�ress Street, Suite 100
�- octan,IU-4 92114-2017
www.mass.gov/dia
(N yu
Workers, Compensation Insurance�idavi�t: Bidders/ConfraetorslEleP�ase PrintLe e�biv I
A [leant TuforutaLiorr
f �
Name (BusinesslUrganizatiou Individual): I
Address: g
F41
te/Zi
n employer? Check the aQ ropriate box:
Type of project(required);
Ia er with 4• %1 am a general contractor and X 6 New construction
a etnQ y have hired the sub-contractors loyees(full.and/or part-time).* listed on the attached sheet. 7. ❑Remodeling
a sole proprietor or partner- These sub-contactors have g, ❑Demolition
and knave no employees employees and have workers' 9 B��g addition
ing for tae in any capacity. comp.insurance.$
workers' comp.insurance S We are a corporation and itsi (]Electrical repaas oraddlians
ired.] ot�cers have exercised their i l.❑Pg repairs ar additions
a homeowner doing all wor�C right of exemption per MGL 12,[] of repairs
mysal£ �Io woriters' camp. c, 152, §1(4),and we have no fI
insurance required-j t ,�Dl4 r7L�
13. Other
emplo�/ees. [,No workers' e- f•U ��
comp. instuance required.]
1n7 applicant that checks box f!1 roust also fill out the seclsan below Showing their workers'compensation policy information.
t Homeowners who ccheck this box must vit indicating theY are doing all work and then attaehed an addition sheet showing the none ofthe nth ccontraetors and statz whether or notar-,must submit a new ott those entitiontrac es have
tCnnlrtctors that ch
employees. If the suh•coulractors have employecs,they must provide their wnrirere comp.policy number. i
I acts an employer that is providing workers'campalisation insurance for my employees. Below is the policy and job site 1
infonnation.
Insurance Company Name:
1,5—
_ Exriration Date: /
Policy#or Self-ills.Lic.#: ` J
city/statelZip:
Job Site Address: page g Policy tratlon date
Attach a copy of the vvorltcrs' compensation
Section.25A of MGA,C. 1,52 can lead totheimposition of criminal penalties of a
>~ailure to secul-0 coverage as required tuiOp WoRK
foe up to$1,500.00 and/or one-year�s B wed that a copy of this as well as civil statement s ill erm be forwarded to the Office ORDERanda e
ofup to$250.00 a day againgt of a ST
the viol
Investigations of the DIA for insuz ee coverage verification. !
.�Si
do:ere�by �e:r the,palrss and penalties of perjury that the information provided above true S�carT�
Date:
e
phone#:
D
Official use only. Do not write its this area,to be completer[by city or tow77::]
City or Town'
issuing Authority(circle one):11.Board of)lealth 2. Building Department I CitylCown Clerk 4.Ele6.otherCo�atact Person: n ,>�
... ...... ............. ............. ...... /1
� ��:`' +<_; LC� p.�-�'�'��-���:L-�.-�:��.�l�e.r%�' �:f. ,�' �.������i�C� 't/,iC�c�iri'L•:.�'
Office of Consumer Affairs'�nd Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 0211.6
Home Improvement Contractor Registration
Registration: 126893
Type: Supplement Card
THD AT HOME SERVICES, INC. Expiration: 81312018
MARK N IADNA
2455 PACES FERRY ROAD, HSC C-11
ATLANTA, GA 30339
Update Address and return card.Mark reason for change.
SC.a t :i TUfv1-()5II7 -
Address ❑ Renewal D Employment Lost Card
pffice of Consumer Affairs&Business Regulation License or registration valid for individual use only
before the expiration date. If found return to:
',- ,NOME WROVEM ENT CONTRACTOR
Office of Consumer Affairs and Business Regulation
1�
)`< Registration: 126893 'Type: 10 Park Plaza-Suite 5170
Expiration: 8/3120'18 Supplement Card Boston,MA 02116
THD AT HOME SERVICES,INC.
THE HOME DEPOTAT HOME SERVICES
MARK NIADNA
2455 PACES FERRY ROAD,HSC
ATLANTA,GA 30339Not vali withokNot without signature g
0
;� F
t _ -
RICHARD KEYES 11
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ENC. .. RiD
SALEM ` 3,079
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