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HomeMy WebLinkAboutBuilding Permit # 10/25/2016 0O RTl{ BUILDING PERMIT 0t.. '6� 0 TOWN OF NORTH ANDOVER 10 APPLICATION FOR PLAN EXAMINATION Z , _ / - Date Received �paRArea Permit No#: ° � �sSaCF"IUS Date Issued Zr Il1�IPORTANT: Applicant must complete all zteTns on this page G �OCATiON U. rpt I PROPER WNER Pant '00 Year�tructure yes g nn g F MAP PARCE L �OIVING DISTRICT „_;H[stor�c Disfrtct Yes no Wo NO S17op Vii age ;::.Yes no r TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New ilding ❑ One family ❑ Two or more family Li industrial ❑Ad ion ❑ Commercial ❑ eration No. of units: Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 'Septic D 11Ve11 ❑ Floodplain ❑Wetlands ❑ Watershed Distr�c ❑=WaterlSev�r�r _ DESCRIPTION OF WORK TO BE PERFORMED: S Ca ce � -r tJ JO 14IJ fVR4t, eS� Identification- Please Type or Print Clearly OWNER: Name: 1% r i S S doh'- Phone: l Address: r ° Coritracfor Name. WGAi .r �- r Phone Address; r � XP' ::' Date .� Supervisor's Gons#u�c:1on License: 02 Exp.: D Horne Improvement Ltcerjse: .ate.. ARCH ITECTIENGINEER Phone: Address: Reg, No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTWATED COSTBASED ON$125,00 PER S.F. Cly Total Project Cost: $ � � " 1 FEE: $_ � Check No.: _Receipt No.: - NOTE:E: Persons contrcreting with unregistered contractors do not haveaccess to t e guaranty fund -_.. .1`. Si nature of Contractor .S pq ure_of AgentLOwner �- _g- t%ORTpy Town of s _ IT. 6 ndover ® ;" [�► No. _ - - y II ver, ass o R h ,,, > Mass, 26-241(v COC�kIC�1�WICK Ab 04Arep C7 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System MTHIS CERTIFIES THAT ..CAW. .145..... M11106W. ..f�. ... .`,. ............... BUILDING INSPECTOR .�.. I'� ..wao ,� ...fe.--APP.. Foundation has permission to erect.......................... buildings on ... 9tPLCM?jT Roug p ..� .. .. ..... .. ... .1. . i .�I.P.................... Chimpto be occu ied ashey 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 Rough Service .. .. ..,..... .... Final WING INSPE OR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. IFT 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: 9586431 [�C�h�risHa n�sberry� Lead 9 First Name Last Name Branch Name KF��:rrwood Ave, North Andover, MA NORTH ANDOVER MA 01845 Customer Address ity _State Zip (978) 943-1612 Cell PhoneHome Phone li Work Phone# cFhristopherhansberry@gmail.com -Customer E-mail Address NOTICE OF RIGHT_T_0CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit I Shrewsbury MA 01545 Address City State Zip or Email CustomerCancelIationNorthEast@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 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: 10/01/2016 X Date �urtomee:71�ignature Distribution: White - Home Depot Yellow- Customer Copy a[tT10t.0I1 V`�IridO;j�is r•. a LVt':k3A',NJ . j p„CiZSs Argon L �.3r'�75 �antac la•1e dobiwguillo - `ina Viniio 3.'8r�Vidrio Argor. Loan-c Sir, a rd Fnr�st ai4an Viur.olaminado Conrejilias � CPD.SSP-A-44-21042-00002 07-75 DH ENERGY PERFORMANCE RATINGS EVALUACION DE RENDIMIENTO ENERGETICO U�actcr Solar Heat Gain Cop-Te'ernt u,;cf-� �aa6:ar;a:�aar:arcia r;a=rsv�Ea o'�- 0.29 1 .65 0.24 ADDITIONAL PERFORMANCE RATINGS EVALUACION SUPLEMENTARIA DE RENDINUENTO R Visible Transmittsace 0.45 I :Liar .3lurarCll;�,,.,In ral'.hP�a-aarga.or n f acp'r_so F. g.:�:d..:r+e.`ori r-3'rG-rcls pr=.d�:t]d'�r arca.N FC aur}aro Sri A,)S }'-13f:'SY4PZ ��,;2.,I:.;:7f'sf7s'�'1.1.�1`ir 3fy i3�%•;.7,a.,..,oar.T.3f rtnm tor'.;i5a 6u-3"] .9`2C::frCl?i';hGl'�5 0:i9'r2V0r%.::�G14.9P Ji 9 Jf ]Z :7:'Sf1i3 3D.lvi Z- "2 1s49rP.!?I:a Z 9- 7 ai G 7 13k fig US"r3EL(59 m�anda JAI "t L 3 ..8ir:3 orf _ iil5 af3d�:i Y?N.ii y 1 �f f _ Unit qualifies for ENERGY STARS region(s):Northern, %f North Central,South Central, ' f Southern. SM 29 IND:Rein OO/Glass ProSolarIH-L.C25 DP;+25/-25 Tested Size:48"x 80" Florida Product Approval:FL51 E7 Applicable Test Standards'>: ANSI/AAMAINVVWDA 1011i.S.2-97,AAmAfWDMAICSA 1011i.5.21A440-05,AAMANVDMAICSA 10tA.S.2IA440-08, f , A440S1-09 Canadian Suppi 8858790/01 80333 HS Howard 6400094A .f�pu`._. dC'' rr;C G� x�., 1_.r o i a..--r� dS r daT 3Jr�r I -M 4'f' _3j>di.7•)'1 CLdTjd Bs;c?1„u9ta Cs,D18S-2erTla_.�S i='`.ERa AKS`�,.;fl.:'.?.dTB53C.._n a99slu,lSI.?,`kW'Y @Il,'.Y Stof gcv r r � ,. .� i.•ti.- 1��1�'J's•Y.'J'.v���'.Y c-d 4 �. l�-IjG'L� Y;�� '•���'• `�L���•�Y�C..,Y�G�'cd•I J�J�' Office of Consumer Affairs rand Business Regulation 10 Park Plaza - Suite 5170 ]Boston, Massachusetts 021.16 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: 81312018 MARK NIADNA 2455 PACES FERRY ROAD, HSC C-11 --- ATLANTA, GA 30339 Update Address and return card.Mark season for change. (� Address Ej Renewal L-_] Employment ❑ Lost Card `= [fffice of Consumer Affairs&Business Regulation License or registration valid for individual use only P before the expiration date. If found return to: fOMEIMPROVEMENTCONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 126893 Type: 10 Park Plaza-Smite 5170 Expiration: 8/3/2018 Supplement Card Boston,MA 02116 THD AT HOME SERVICES,INC.. THE HOME DEPOT AT NOME SERVICES MARK NIADNA 2455 PACES FERRY ROAD,HSC :�ti•;• —— _ A7AIVTA,GA 30339 ecreta Nat vali �h�,,tsigat,,, Undcrs ry v T 1t e Common� cultlt of 9assach useds Department of Industrial Accidents ! u office of In"Jestigationi` I Coltgresr sn eet, Suite 100 t Boston,AM U11144017 x>ww mass.gav/diU eMactors(E]ectxlumbers -Vnrcers' Compensation InsurantcPlease Print Le bly614 M I � licant Xnfo�-matior� � ', f Naide (BusinesslQrganizatioa/lndividual): 1 ke-- 44 Addzess: ' Q �t,j �- � : �Ch�eck 1 J11' IIIIIIIIIIA- © 5�> Phone#; hype o1 project(required): pioyer? the ap top 4. b 1=a general co=actor and I 5. ❑New construction 1.❑ 1 am a employer with�_. ha is hired the sub-contractors employees(full and/or part-time).* �. Remodeling listed on the attached sheet. ❑ ! _❑ 1 am a sole proprietor or partner- 'these sub-contractors have $, ❑Detnolitinn ship and have no employees employces and have workers' 9. ©Building addition working for me in any capacity, comp.insumce.t NJo workers' comp. insurance S. ❑ We are a corporation and its to,[:]Electrical repairs or additions required_] officas.have exercised their 1 l.❑PL mg repairs or additions .❑ 1 am a homeowner doing all wo'r c .dght of exemption per IvIGL 12.❑ of repairs myself pio workers' comp. c. 152, §1(4),and we have no insurance.required..] $ 13. Other tployees. [Na Workers' , n rJS comp,insurance rzquired] �.1 ny applicant ghat becks hex l must also tall Outs a s d in e��work and then bice Outside omractars most submitzania affidavit indicating sccb� t Homeowners who submit this affidavit indicating ey g tContxactors that check this box must altaolied an additional sheat showing to name ofiha mb-c io[Iry numt6er.and state Whether Or not tbOse entities bawe employees. if the sub.coniractors have employees,they must provide their woaftw rkers'camp,Q I on an employer thefts pravidin;workers'compensation Uu-aTatce for my en:ployees. Below is the policy and job site infonnation. insurance Company Name: ' / Expiration Date: Policy#or Self-ins.Lic.#: j� !/ r ctldt) I Pie, � 7 City/StatelZip: Iv 2. �csJcY` Job Site Address: Attach a copy of the workers' compcnsatlan policy declaration oFMGL p l S2ge(a lead tshowing o the tlimposition of criminal penalties iley number and expiration of a Failure to secin-e coverage as required under Section 2SK ORDER in the form of a STOP WOIU- fine up to$1,500.00 and/or one-year impris B wed that oscopy of#lair civil penaestatement may 6e forwarded o the p o d a fine of up to$250.00 a day against the violator. Investigations of the DIA for insurance coverage verification. I do hereby a nder the psi nd penallies of perjury/hal the reformation provided above �d�correct. Date: Si9Pature: L Phone#: g official use only. Do not write in this area,to be contplefed by city or town official_ ! l p Permit/License # ! City or Town: i issuing Authority(circle one): t 3.CttylTovvn Clerk 4.Electrical Inspector S.Plumbing Inspector 1,Board of Health. 2. Building Departmen S.Other PtibnE#: Contact person: -F' 1 OA r�;MWDDr('/'/Yi �c >t CERTIFICATE OF LIABILITY INSURANCE j THIS CERTIi=1C,ATE IS ISSUES] Aa A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERT1FICAT„ DOES NOT ArFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CL RTIFICAT= OF INSURANCE DOES NOT CONSTITUTE A CONTRACT SErAIEEN THE 15SUING INSURER(S), AUTHORIZED RCPRESrEN-rA TSVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the POlicy(ies) must be andorsed. If SUBROGATION 18 WAIVED, subject to E the Germs and --onditions of the policy. ,ertain policies "ray rsquire an andors3melTt. A statement an this cart'sficate does not;onfer rights to the certificate holder in lieu of such endor orrent(s). CONTACT PRODUCER NAME: ----- NAPSH'JSA,'MC PHONE W (Pic Il O ,•y"-r^ T=.� tAl�No Eztl: A1C l �L Is,c ,E,I,_. E-MAIL ADDRESS: a INSURER(S)AFFORDING COV _Ai`f�A.'iA 10326 MAIC I COVERAGE 190492-r,omer- "N'.!n I INSURER A:Sleadfasl'nsuranceCompany 25387 INSURED INSURER 9:Zurich Amarican Insurance'; "wCSSL-1.0.6006 BENJAMIN PARKER 43 U .' Plaistow NH 03865 O:nl.