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HomeMy WebLinkAboutBuilding Permit # 12/28/2016 OORTH BUILDINGVERMIT 0 TOWN OF NORTH ANDOVER P PLIC TIO-AN FOR PLAN EXAMINATION Pe Date Receive rmit NO-� d 'S , Date Issued: CHUS IMPORTANT- LOCATION "e, PkOPERTY OWNER, MAP NO.,1._IPARCEL: Print , todc istfict —L7ZONING DI'STRICT:— Dyes no Machine Shop Village yes no —-----------------------—--------------------- ----- TYPE OF IMPROVEMENT OS PROPED USE ------------ Residential Non- Residential 7 New Building )tine family Addition Two or more family Industrial Alteration No. of units: Cornrnercial Repair, rewacement Assessor y Bldg Others: 1i DemoRion Other S We Floodplain oWetlands, Watershed District eptic H 7o Water/Sewer ----------- n rv� Identification PleaseType or Print Clearly) 7 OWNER: Name ,–rz Phonei�",,� h Address: ............ CONTRACTOR Nafh6: Phon N) Ut –±,,LI J "o Address: Z,/;�,'A,1)1 i"T Supervisor's Construction Ucense�: EDate. Home Improvement License: Exp,, Date: p, CHITS UENGNEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT. $1ZOOPER$1000.00 OF THE TOTAL ESTIMATEDCOSTBASED ON$126.00 PER S.F. Total Project Cost: $ ✓ —FEE: $ Check No.: V Repee No.: 7e NOTE: Persolls cont1 awctt e fwl contractors do not have accessto th, n a itid Signature of Agent/ Sig nature of wn contractor ............. ...................................................................... 'T SORT"own of . Andover No. h ver, Mass, o COC..C.'..0 4,0 BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ...or . ..................................................... ..... BUILDING INSPECTOR has permission to erect.......................... buildings on .. ft 41AP.00. ......4s.ri........... FoundationRough to be occupied as ........(i......... .............#..........Jr.A.A0.4f.....AC*jP#?.. 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 CONSTRUCTIOWA TS Rough Service ............. . ..........I....................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupr Building 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. u HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,furnished and Installed by: Branch Natne: New England late/�A f(A THD AL-110111c Services, Inc. d/b/a The Home Depot At-Home Services Branch Ntmaber:31 908 Boston Turnpike,Unit 1,Shrewsbury,MA 41545 Toll Free 877-903-3768 Federal ID It 75-26913460,ME 1-ic#C:02439:RI Cons.Lica# !6427 CT L'ac#IdIC,0565522:MA Houle Improvement Contractor Reg.# 126893 Installation Address: _ City State Zip Purcllaser(s): _ Work Phone: II011le Pholle: Cell Picone: - [ IL I Hoarse Address: (If different front Installation Address) City State Zip E-mail Address(to receive project cottlmunications and Horne Depot updates): ❑ l DO NOT wish to receive any marketing entails from The Dome Depot Pro'ect Inforltaation: undersigned("Customer"),the owners of the property located at the above installation address, agrees to buy, and THD At-Home Services, Inc. (`:The Houle Repot')agrees to furnish, deliver and arrange for the installation ("Installation") of all materials described on file helotiv and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (coliectively, "Contract"): •Inn Ilnlermd rtca'rcntie.) Products: Slice She _ Project Amount Booting Siding 0 Windows Ll Insulation $ �� l ❑Gutters/Covers ()try Doors ❑_ r ❑Boofing ❑Si---idil1 vllldows ❑ 111sulatioll ` r t t+Ca'S :Illi +taaCla h _,,,_,_____ ����� 9 L Itoofrnb []Siding 0 Windows lnsuladion ❑Gutters 1 Covers ❑iattry Doors❑ ❑Boating Siclin�, ❑ ���indaws ❑ hasulalion —.___._—_.._ �. --- ❑Gutters/Covets ❑Envy Doors ❑ .- _..� Minimum 25%n Dep( U of Contract.Amount dile"lion execution of this contract. Total Contr aet Amount $ (09 rvlaitie Purchasers may not deposit more than ogle-third of The Corin-act Anio nit. Customer agrees that, intrllediately upon completion of the work for each Product, Customer will execute it Completion Certificate (one for each Product as defined by an individual Spec Sheet) and pay any bal=ance due. As applicable, each CoStanher tinder this Contract agrees to be jointly and severally obligated Land liable hereunder. `fhe Horne Depot reserves the right to issue a Change Order of terminate this Contract or tiny individual PI'odLICt(S) iuchtdtd herein, at its discretion, if The Home Depot or its authorized service provider deternliraes ttat it ctttnlot perforin its obligations due Lo a Structural problem with the home, environmental hazards such as mold, asbestos or lead paint, ()tiler safely colacerus, pricing errors or because wort:required to complete the,job was not included int[hie Contract. Pa,anent Sullinlalr, 'file Payment Sunlncary If__...-1, ��� _, included as part of Ibis Contrtict, sets forth the. total Contract amount and payments required for the deposits anll Final payments by Product(as applicable). NOTICE TO CUSTOMER You:are entitled to a completely Blied-in copy of the Contract at file time yota sif;u. 1)<1 not sign at Conapletialtl Certificate(note: there is one Completion certificate ftsa-etacll listed Product as defined by individual Spee Sheets) before work oil tll:af Product is Complete. In the event of termination of this Contract, Customer agree=s to flay The Home Depot elle csrsts of maturials, labor, expealses and services provided by The Home Depot or Authorizer! Selwjee Provider through the (late (ifternaillation, plus ally Other <tttlounts set forth ill this Agreement or allowed under applicable law. THE MOVIE L3um NIAY WITHHOLD W01JN`I'S OWED TO THE HOME DEPOT MOM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHour LIMITING THE HOME DEPOTS OTHER REMEDIES' FOR RECOVERY OF SUCK Al f€UNT& Acceptance and AL41Dorirat1011' Custermer tl,grec5 and understands that [his Aorc,enlent is tite entire agreenaerll between Customer and The 1-lome Depot with regard tsr the Products and Installation sCJ-vi.ce� and strpersccles till prior chscilssiont s and agreeme1w." cilher ol'al or written, relating to said Products and installation.This Agrc;ement cannot be assigned or aMCMIe.d except by a writing signed by Ctrslrnncr and 1.11 - Depot-. Customer acknowledces Land agrees that Customer has read, tnI&I'StandS, voluntarily taccclhts the tennis of cmc ,s recoi ed a copy of i s Agreenlcnt. WINDOW SPECIFICATION SHEET - Spec.Sheet#f: 9739298 Sheet: 1 of 1 Customer: Robert Stowers .lob##: 9739298 Consultant: Leonard Racde Date: 12110/2016 New Window Existing Window Hinge Locations Measurements Gods Product Options Labor Options From outside, Left to Right Bays,Bowis Location Color Rough Opening #of bars #of bars Csmnts,1 PH, use L,R or S Glass !disc Items Hwdware Code Screens f=or doors use _ o _ Mull "S"=stationary or "X"=operating w Room Floor Code (YIN) Style Cade Series Code EL 7 x 3 S STD,Gla Pack:Standard WRAP,LSR 1 LlV ?st 64 Y 64 6300 WH WH 97.00 $3.00 150 F.GBG WH.WH G ALL 1 3 ALL 1 3 L 5 S R STD,GlawPack:Standard WRAP,ISR 2 BED1 1st DH Y DH 6100 WH WH 43.00 53.00 96 F,GBG WH,WH G ALL 3 1 ALL 3 1 STD,Gla=Pack:Standard WRAP,LSR 3 BED1 Sgt DH Y DH 6100 WH WH 43.00 53.00 96 F,GBG WH,WH C ALL 3 t ALL 3 i STD,GlassPack:Standard WRAP,LSR 4 BED2 Ss[ pH Y DH 6100 WH WH 43.00 53.00 96 F,GBG WH,WH C ALL 3 i ALL 3 1 STD,GlassPack:Standard WRAP,LSR 5 BE02 ist DH Y DH 6100 WH WH 43.00 53.00 96 F,GBG WH,WH O ALL 3 1 ALL 3 3 STD.GlassPw*T Standard WRAP,LSR6 KITCH #st 83 Y B3 6100 WH WH 59.00 37.00 SOB F,GBG WH,WH C ALL 1 3 ALL 1 3 L 5 R SPECIAL CONSIDERATION& Wrap Color WHITE nterior Casing Type Colonial Bay or Bow window: atboard material(vinyl only-Birch or Oak) Oak Bay Project Angle(30 or 45) Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) 5 If tied to soffit,cotor of soffit material WHITE I have reviewed and agree with all the job specifications above and the Construct Roof(Yes or No) Yes Special Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Picnite,Birch or Oak) Wall Thickness(inches) Customer Signature Additional Shelf(Yes or No) "There is no guarantee that new shingles will match existing cotor. 112"G'; s= Argo.! Lotti C.NO u.. j dode gLAIOhna-`rpj!ra-I:'.ri.M,6 fidao•Argua:"z.Gs t So it moi`-ERI v P gRRD a.NE:° NI(;i-RAT[mg-'s l` X11:;t.ACIONDIE RR11DIINlMs}i0„i,f2P,G3riEGt7 'i l:-=cols. ': $�:fBCil�iia"•-licitluii.:?i!_ s� --[i IONPL PEE7Rs0-PMIARGE Rid i INNS '3 +fiiLC3 wlOiE wilP? i RIP Ba gr-HRUtIO-M fi :S o a 4z;5 - Is ii 1' ^ray. - -r ': ur.� G;=;iY•'l %�=^�f• U;li�qu;:fiseE f .[ ..��ar1=h.�CY • !: �I�_ _-;••� �.%�il;::~.''`'t?"`-!f!�'�� SiikaCi[�a1c11[�}.ZiQ�;aP]• r �:.�:F l� :. }'%'=•:+t'%lJ. r1:It l.;_ MGM central, > Scurnem- -713 !� a"!,� � -'1-25 ... �, _,J itlr!C:^�inQQfG;ass©rnSoi2rl�-LC�� '[ iJ 1 i w5i2! BIZ : ` X 50” i [ �rt :y �� 43�a G3'vS`• nS1511 ����I?41;1=�'1��'lD�fi.'�.^-�Z:F�.A;s!rr[illV�9a3rNCS� Il ;� [.;�12G5 i••1Lo.G?[� �l_T451;,e7�: alt u�$v$f�Q(f�'! t7,U333 �-IS !-f4z:2C7 [� I �I _ ___� �V:'.xi_.._... a==._'.=+�. ...._ ...�_r•...�Y-�•.[_-_^�r_.—.•.;Y. _�S.Y'y G.:.'�-.3.��.•i•e r! The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suitt-,100 AIA 021!4.201 7 ww w.mass.go v1dia Workers' Compensation Insurance Affidavit: Builders/Conti-actors/Electricians/Plumbers. TO 13E MLED WIT11THE PERNUTTING AUTHORITY. Applicant Information Please Print Legibly ,z Name (Btisitiess/Oi-ganization/Iiidivi(Itial): rwfleT e t-�-zv)62Z- Addf ,- i-ess-, a. _ hone#: city/state/2 Are you aw employer?Check the appropriate box,: Type ofprojeet(r'equir'ed): I-F-I I Rraa employer with-------,employees(full and/orpart-th-fle).* 7. New construction 2.Fj I am a sale proprietor or partnership and have no employees working For me in 8. 0Remodeling any capacity.[No workers'comp.insurance required.) 9. F-I Demolition 3.[]I am a horneownerdoing all work myself.(No workers"camp.insurance rcquired.) 4.R I am a homeowner and will be hiring contractors to Conduct all work on my property. I will 10 n Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12,[:]Plumbing repairs or additions 5 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[—]7Rof repairs These sub-contractors have employees and have workers'comp,insurance.* 6.[:]We are a coifioration and its officers have exercised their right of exemption per MGL c. 14JI2,0ther 152,,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks be.\:#I must also fill out[lie section below showing their workers'compensation policy information. t Homeowners who submit this affiLdavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must nuached an additional sheet showing the name of the sub-contracture and state whether'or not those entities have employees. If the sub-contractors have employees,they must provide then workefs'conip.policy number. I am an emploj,ei,that is pi-ovi(thig ivoi-keis'compeitsafloit insiti-aitcejbi-my employees. Below is the policy aii(Ijobsile infol-niation. IV 4 1 Insurance Company Name: Policy #or Self-ins.Lic.M Expiration Date---.-.., Job Site Addi,ess: City/State/ZipU-- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(late). ✓ Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a line up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of tip to$250.00 it day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, 1(10 11n eby cei-Ii V tyke t Upena ties afpeijury that the hijbrinatioit provided above is true mil correct. sl? l7atut:� "ot Date: 122-- Phone#: b2- Official rise wily. Do not write in this area,to be completed by city or town qjflcial, City or Town: Permit/License# Issuing Authority(ch-cle one): 1. Board off-lealth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector- 5. Plumbing Inspector G.Other Contact Person:— Phone DATE th1hVDD)YYYYI A,00 T73O CERTIFICATE OF LIABILITY INSURANCE 0212b2016 I'HIS 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 13Y 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: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION 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 Bolder in lieu of surh endorsement(s), CONTACT FROQUCFR .•... NAME! MARSH USA,IPIC -- — FAX 1 photic TVIOALLIANCLCLNIEH tAtc.11o 35E0I.F.IdOX ROAD,SUITE 2.10`3 E-MAIL KrUN I1 A,GA 303'2..8 nnoRl ss: INSURERISI AFFOROMG COVERAGE. NAI[i! _ 10[3492-Nfl1i16�-GA41''-16-17 INSURER A:StEad#1 11nsuranctl Cerrynany 26,87 MSUR1 D INSURER 11:7Urich ARlerican Iris Mance co 16535 THE HOIME DEPOT,INC - - --- — _ ' S IOI0E-DEP0'1'US A,INC. INSURER C;Ne-V Hantpshhe[ns fb 23tZ11 1 2455 PP CES MERRY ROAii,N4i' SURER D:Eltinrns Plational 111,3 nr rlce CvnlPally 23817 I fllllLLiiNC,C;JO -!N — ••-:. .,, - INSURER E: FN5UR ERF COVERAGES CERTIFICATE NUMBER: ATL-003741310.06 REVISION NUMRERt 0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO Tf-IE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDIT$ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8E 1S3UED OR fv1AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBtECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IfJSR - LIC EXP TYPE OF INSURANCE OD S BR POLICY NUMBER M ;uDPOLICNYYY Is1Mtp0lYYYY L1trliTs LTRNSD A X COMMEROAL GENERAL LIABILITY GLC?�l$$7714-06 0310112016 ONOIDD17 EACH 0CCURREI.I1:1 S DAfAAUE 10 REN rFD CLAIl,4S-fdADE OCCUR - MISE-9 PR (Ell-0-Trencr) S _ i,CLA7,U00 LIMITS OF POLICY XS1 SF€7 LXP(An y one EXCLUDED _._..._..._. .._..__-..m.�T,_. IPiepnl S -- - OF SM:SIM PER OCC PERSONAL a ADV INJURY S 9.Or�,000 13Efd'L A00REGAT'F L1141T APPLIE5 PER GFNFRAL AGGREGATE S �• •U��' P4LiCY L �JE T LOC PRODUCTS-COIAPlOPAGG S E 41HERl U AUTOMOBILE LIABILITY BAP x;138853-130310112016 0310112017 CCIIRtNED SM6LE UTAI r $ i CC?CCU (Ea_acvc%nt1 _ soulLY lrl t1HY p er 1 rrsnny 5 I fiblY AUTO l ALL GY'didED sCHEDULED SELF INSURED AUTO PHY DMO BODILY IMLIFY(seer a(.rinent) s !AUTUS I AU ;LTQ6 !!! _._-.. ---- ---.....__.. I `81-t7'rVi•!ED PROPERTY DAL!AGE 5 HIREDAUTOS AUTOS UMBRELLA LIA9 � OCCUR -� EACH OCCURRENCE S ._ EXCESS UAB GIJ,11 34AADE AGGREGATE 5 DED RE-TENTIO -S 5 {; WORKERS COMPENSATION 47i 1r+1�2 tr(AOS) (YI,r0112{'1Fr 03if}I12r!'7 v 81A OrH AW EtAPLOYERS'LIA0ILITY - ;•TATU7E—JI.-I.- YIN j_.-_-TER, t' AI4Y PROPRiETORIPARTNEPirXECUTI`JE YNN N!A tn1C0i5519217(AK.KY,NH,NJ,VT) 031011'2015 0210112017 FL EACH ACCIDENT 5 OF FICERAtiIE11,BER FXCWDED? D INC0155y9 IG FL 0310112016 0310112[!$7 _...LT 1,0[3 1,0[0 (Mandatory in 1!H] { ) E.L.DlsLnsE-to EMPLOYE S 1;Yes,uesClibe under C911ttndcd ori Add:IlOn31 PAP i.00O.I:fU DESCHfI'TIOII OF OPERATIONS haloes 9' E.1. OISEASE-POLICY L1151T S E DESCRIPTION Or OPERATION 81 LOCAMNB 1 VEHICLES(ACORD 101,Addilinnnl Remarks Schedule,may be altacbed If more space!n required) CERTIFICATE HOLDERy� CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE fCCDOSW IODS,l THE EXPIRATION DATE THEREOF, NOTWE WILL BE DELIVERED ITS NORTHA,NDOVER,hY, OH1435 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of tlarsh USA#nc. l:lanashi tilu$chefjee .�'�.C�v��••�. ,`'s'[n..:r_.r�v.�-�.i 1984-2014 ACORD CORPORA!ION. Ali rights re5erVO(i. ACORD 25(201401) The ACORD name and logo are registered marRs o4 ACORD • k _ F t Office 0f Consumer Affairs ' nd Business Rea i a.ti® 10 Park P a.z,,-�-,, - Suite 5170 Boston, Massachusetts 02116 Home1-r-Li-provement Contractor Registration Repistrabon: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: 8/3/2018 RICHARD TROIA 2455 PACES FERRO' ROAD, HSC C-1 I ATLANTA, CSA 30339 Update Address and return card. Mark reason for change. Address Renewal Employment East Card Office ofQms'a aierAffairs &Business Regaalation L cense or regastratson valid for endaTadual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to. Office sof'Consumer Affairs and Business Regulation - Registration: 126893 Type: 10 Park Plat - Suite 5170 Expiration: 8/3/2018 Supplement Card Boston, MAA 02116 THD AT HOME SERVICES, INC. THE HOME DEPOT AT HOME SERVICES RICHARD T ROIA 2455 PACES FERRY ROAD, HSC r , AT�AIUTA, GA 3[1338 ei�oc' �-iTndersecretary of without siinature CSSL-4 99699 ROBERT POcZOUT 172 WHALERS LANE SALEM MA 01970 02/08/2018