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Building Permit #870-14 - 100 COVENTRY LANE 6/2/2014
_ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: *4PORTANT: A licant must complete all items on this page LOCATION .'. _ .. 'Print! PROPERTY OWNER Print 100 Year Old Structure yes o MAP NO: �f PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT. PROP ED USE Res' ential Non- Residential ❑ New Building One family ❑Ad ion ❑Two or more family ❑ Industrial ❑ teration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION PEWOR E PlEIRFORME f I' I entification ease Type or Print Clearly) OWNER: Name: Phone: Address: Al q,, CONTRACTOR Name: . 4 to Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: - z Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i Total Project Cost: $ f FEE: $ Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have accesWganand ignafure ofSegature of contr4Plans Submitted FE Plans Waived ❑ Certified Plot Plan ❑ S Location No. 'Sip- 14 Date Z TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ` t Check# Building Inspector --:-Plans Submitted ❑ < . Plans lllaivedfl..: -.Certified Plot Plan ❑ Stamped Plans ❑ FYPE_ORSEWERAGEDiSi�O AL" Public Sewer ❑ Tanning/Massage/Body-Art El... Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ - :Private-(septic tank,etc- -.0. 'Permanent D empster.on Site ❑ 3HE.FOLU . ING SECTIONS FOR'OFFICE USE ONLY INTERDEPARTMENTAL SIGN.OFF-- U FORM _ -- .---DAT E.REJECTED- .-- DATE-APPROVED PLANNING & DEVELOPMENT' [] ❑ COMMENTS _CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature f COMMENTS f Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 1 Conservation Decision: Comments Water& Sewer Connection%Signature �.Da#e - Driveway Permit DPW To` o Engineer: Signature: - Located 384 Osgood Street FIRE-DEPARTM-f-INIT Terri.p-Dumpst&on site yes.. _ no Located at:124-Mair Street _ Fire Departme►ittsgnature/dafe C011�M.ENTS " r Dime siorr Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area,sq. ft.: -ELECTRICAL:-movement of.Meter. locatiron 'mia'st-or service drouires a Elp _ectrical Ins ector Yes N® p req pproval of DANGER-Z®NE LITERATURE: . =Yes No MGL.Chapter166.Section 21A._F and G min.$100=$1000.fine NOTES and DATA— (For department use i �I ! EI Notified for pickup - Date i E E L ff j Doc.Building Permit Revised 2010 i I Building Department -The folibwing is'a=list of-the:required.forms to be-filled outfor:the appropriate permit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of KI.C. And%Or=C:S.L Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire'Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apwal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Building Permit Revised 2012 � NORT own of - -�II ¢ Andover Q y" X11 No. - I i � aa� o Ih ver Mass u �. > A- coc L:"14 Hca_�1' 7�pDRATED IkQP��G, S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT .....PERNIT .Aveso.... ....aBUILDING INSPECTOR .. rl/►�� Foundation has-permission to erect ......................... buildings on .....� ............. Rough � to be occupied as ..........g..... .. . � .... +. A..................................... chimney provided that the person accepting this ermit 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 CONSTRUCTION STARTS Rough ..... ... .. Service ... ......................................... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildinw 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. II ✓ ,VIS✓iiwi � Office of Consumer Affairs&Busmess,Regulafion Licehse or-•registratron valid.for indrvrdul use only a 6efor the ex matron date.-If.found return to { OME IMPF t SNF CONTRACTOR02. rF Pg i Office of Cohsumer Affairs grid Busyness Re ulatron T e : RegistratN 93 Yt 10 Pgrk.Plaza=Suite 5174 Ex�rtt► Sup lemer�f and $ostdn;'-MA 02.116 � he Home Dep©v es 44 2fi90 CUMBERIA A S: ``� a of valid ithout sr nature q'i'{`A� GA 30339'"���' Undersecrefary , g i i r alth 0. mWe i3e�a�n ondsli fScdes '600A'ilW in.—on..St est B�str�n�� xtdes1C� lleclicinllbcr rs' 'OffiP�asR 0 I uva c .Alf t, w_ k CO r NOV`"4{ kid h 1 " t�siflesslC?rgatuz2tton/lndividual) . .' Address,_ rA t Y6h• .PsT Y' V M np t h:+ Te op . raject(required): � a raZ r� aaiTa�torandI traction '. 4 ` 6 []'New cons 1 ami Qk� vee ' contractors rns j� p e * e a7. ❑l;emodeling � x t cbe eet 2 0 Z ate �Ss be � Qrt F Therese �th-coiitkactois have Demolttlon . Slat rand aveQ 1b ees h r R ' emploXegs shave worYsers g ❑Belding addition wdxltng fo> me31itY. com tnsuxcet :. # o wozkers' omtrance p 10.[ Electrical repairs or additions (N7. 5. El we ire a co{pora�tton and its ret�uiredrsa�e eae�tsed their 11 ❑Plumbing repairs or additions 3 (] taraeav�merdo gallworlt ngti Q x ffipdowPer1VIGI: 12.❑ rep. mlisel€ [No v►rorCers'cbm v §1 �ha e iso Other aired t 13. insurance ireq epap�aye�ea� b�vgrkcrs : r c4inp,tnstm ice req�ed.] ensahon ohc wfo�mation..;'. .. *Ana licant that clleck5 box#t tpu�t aEsa fill out the§ectiop belowhovpm thea�vnrlce►s'comp P Y ... pg s ry i M utsida contractors must submit a new affidavit indicating such. r W k L S }f omeown�rs who ubtrut Q snap t�ndieatwg flux are doing all xpe a�'� f the ub contractors and state whether or not those enhhes have }t usl itae ed add►honaY sheet shotm�iii rtz£m #�Qatr�ctOrs t>iat c eek flus boXm� a ey em eef if the s b-cAnhactotsYe sloeest th must provide#heir twctrlEers'comp policy mtmber i P°Y .oli and'ob site to ees Below rs thep.. ..cy . 1. . ti ,c nce for raelr }�. e Yo er#hal; root lag wotke omp004WOM lnsura em ;t:a? .am y --- nfortttlun.In CopanY ) cpirationbate: I'oltey#or Self ms I.tc City/Statp.7ip Jotx Site Address 1t�tion date U t .' p the itc muntber and exp`.. .: ). ttaeh a'coix® the s�vorkers'cQrii � o,SuepCton 2 A of MGA,c 152 than lead to:tli tmpos}tton:of criminal,penalties of a failure toeeure coverage as Xeq�tiX y QUER p..., . .•...'...• fine u to$t,S0050Q and/or one Year unpisoi►mel?t> yell as civil mals statem nt may be forwOardedOto the Offic of d 21 fine p oup tq$�50 00 a da against the �lolatr4 Be adI. yMi..,hat a copy of ilii UPI cation Tn�tes€igahons e 1J dor insurance cove)ag . FF r, =Y _ , s 3�enaltaes of�ter0reny th®t tdee;i0fOr�eaetaPp provided above as a ran corree�. . Oate �' S'1 stare `' '` s s l � jve m t1�rs urea,to be completed by cify,tir tvx»i_ocaL ,.p�eial use Qhs • ..,.�°..,t . ' j >. Permit/License# �tty or Torn. < Issutng g T Afiit�inty(circle ane) k �1�'of lliealth 2 Y�u�.d>n�.�epar�t�n�nf.�3._C�iylTown Clerk 4 �Electcical Inspector 5.PlumbinnsPector r , phone#: ' Aco 021191/201CERTIFICATE OF LIABILITY INSURANCE DATE Yn' 2014 4 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,EXTEND 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and con_dations 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: TWO ALLIANCE CENTER PHONE FAX AIC No 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 100492-H6meD-GAW-14-15 INSURER A:Steadfast Insurance Company 26387 It4SURED INSURERS.Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. — -- DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 2455 PACES FERRY ROAD INSURER 0:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003242685.01 REVISION NUMBER:3 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 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY A GENERAL LIABILITY GLO4887714.04 0310112014 0310112015 EACH OCCURRENCE $ 9,000,000 DAMAGE TO RENTED 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence $ CLAIMS-MADE M OCCUR LIMITS OF POLICY XS MED EXP(Any one person) $ EXCLUDED OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9'000'000 GENERAL AGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,000,000 X1 POLICY PRO-JECT F-1 LOC $ B AUTOMOBILE LIABILITY SAP 2938863-11 0310112014 03/0112015 COMBINED SINGLE LIMIT 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED SELF INSURED AUTO PHY DMO BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTOS WNED PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ C WORKERS COMPENSATION WC049101882(AOS) 0310112014 0310112015 X we sTATu- oTH- AND EMPLOYERS'LIABILITY YIN WC049101884 AK,AZ,VA 03/0112014 0310112015 1,000,000 I ER C ANY PROPRIETORIPARTNERIEXECUTIVE� N/A ( ) E.L.EACH ACCIDENT $ D OFFICER/MEMBER EXCLUDEDT WC049101883(FL) 03/0112014 0310112015 E.L.DISEASE-EA EMPLOYE $ 1,000,000 (Mandatory In NH) H yes,RIPTdescriIONbe underOFOPERATIONS below 0,000 DESCE.L.DISEASE•POLICY LIMIT $ 1,00 C WORKERS COMPENSATION WC049101885(KY,NC,NH,VT) 03/0112014 0310112015 (EL)LIMIT 1,000,000 C WC049101886(NJ) 0310112014 0310112015 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee 3�4u+.�a�s►.�.� L` ' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD May 16 14 05:00p Rick Odonnell 6033780151 p. l KQME�R�VEi14ENT Cnrrru.,�.�. . l'L� S•-� ASE RAO T flys Branch Name:Boston North$South bate: Sold,Furnished and Installed by: Branch Number:31 and 33 THD At-Home Services,Inc. d/b/a The Home Depot At-home Services 908 Boston Turnpike,Unit I,Shrewsbury,MA O 1545 Toll Free 977-93-3768 Federal ID#75-2698460;ME Lic#C 02439;RI Cont.Lio#164277 Installation Address: / CT Lic#HIC.0565522;MA Home Improvement Contractor Reg.#126893 v2 Y City ! YS Purchase r(s). State Zip Work Phone: Homephone: /•G1,J221t � , [ ] Cell Phone: [ 7 [ l [ 1 Home Address: (If different from Installation Address) EJ E-mail Address(to receive project communications and Home Depot updates):City State Zip I DO NOT wish to receive any marketing entails from The Home Depot Project Information: Undersigned(°Customer"),the owners of the property located at the above installation address,agrees to buy, and THD'd on t Inc. ("The Home Depot")tiers w furnish,deliver and arrange for the installation rens,agreei to b of all materials described on the below and on the referenced Spec Sheet(s), p reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(c llectively, p all of which are incorporated into this Contract by this "Contract"): y Job#: pmeimilRerermee) O"7s-o _7 odncts. S C Shcet(s)#, "`KKK C.� Roofing Siding endows Insulation Pro•ectpA.mount ❑Gutters/Covers ❑Entry Doors ❑ �� y2e Roofing e Siding Windows Insulation ❑Gutters/Covers ❑En Doors� Q S Roofing Siding Windows Insulation ,, es ❑Gutters/Covers ❑Entry Doors❑ $1`111 (/f/!' `J+',ii Roofing Siding Windows Insulation 1/ ❑Guners J Covers OEnuv Doors ❑_ $ Minimum 25%Deposit of Contract Amount due upon execution of this contrail. Mauro Purchasers may not deposit more than one-third of the Cirmtract Amount Total Contract Amount $ Customer agrees that,immediately upon completion of the work for each Product, Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# J included as part of this Contract, sets forth the t Contract amount and payments r _ oral s uired for_• P } ul the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HON4E DEPOT MAY WITHHOLD A-190I OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization; Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot-Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Accepted by Submitted by X Aq�� S X �ice' Gs �l ff Customer's 9iiratlie Date Sales Consultant's Signature Date p X Telephone No. (,<0,s—" 1_5 611 r Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (-applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. --- ..-.-..._._............... ......................n...r.rn.n r.r�wn•..,.,in 111.-C ANT AVC P A PTnv,rnic rnN'r'n&rT .. _ �42iGrti1 �uitC�1�+3 �i=�3.i��alClrtS SLAr(:.7'dt:rs - { on�ructin3�Sip+'rsiitz;Special s: D yn!R% _ 70 113 110N giT, ohs 9 .. • BUILDING PERMIT o* No oTh qti TOWN OF NORTH ANDOVER 3� 4`'`- "`'° ° APPLICATION FOR PLAN EXAMINATION ° � :� 1 Permit NO: 6 < 1 Date Received Date Issued: J� J ' ��SSACHUS�� IMPORTANT:Applicant must complete all items on this page LOCATION `v La ..Print f PROPERTY OWNER_ t^'C.t.11 Print MAP 21fl Q G PARCEL: 1 (!3 ZONING DISTRICT:21 Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildingne famil `y�>q Addition wo or more family Industrial Alteration No. of units: Comm cial Assessory Bldg Ot rs: Demolition Other Septic Well Floodplain Wetlands atershed District Water/Sewer D SCRIPTION OF WORK TOB PREFO MED• Re Rea, i e S y e jIdentification Plea Type or Print Clearly) OWNER: Name: Y7a V p )ter��_ Phone �178•L '$• 58� Address: "10 CO Ve Ar-1 17 605 5V e c - Ae e4 CONTRACTOR Name: -qCom.e- l--OW A `L; Vin, Phone-GO,753• d 4 2, Address:82.'7 I Lm o5 Cm P ✓ h��ter a 5 6-Y7 , CT 06 Z 7:Z If Supervisor's Construction License: � 'I S 12 Exp. Date: 8 .3 E • Home Improvement License: 4 G D '7 Exp. Date: l ARCHITECT/ENGINEER Phone: Address: Reg. No. Ili FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ Jt� con FEE: $ o� Check No.: Recei t No.:p NOTE: Persons contracting with unre istered contractors do not have access to Zthe :uaZranfund ignature of A gent/Owner Signature of contracto I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS i N � HEALI Reviewed on Signature COMMENTS Zoning Board of Appeals:,Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer COnneCtion/sic nature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Locate_d at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine 7 NOTES and DATA- For department use i ❑ Notified for pickup - Date ._._........-- -.. Doc.Building Permit Revised 2010 J Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits VK"Buildin Permit Application 9 pp cation Workers Comp Affidavit � hoto Copy Of H.I.C. And/Or C.S.L. Licenses �opy of Contract Floor Plan Or Proposed Interior Work ,gka Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ ' Engineering Affidavits for Engineered products NOTE.. All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit r In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 NORTH TO" Of And over, 0 av No. - o+� yy�` dover, Mass., S T O 07:� LAKE 1.CMICMEM" V DRATED � Kc:) E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 1 — BUILDING INSPECTOR THIS CERTIFIES THAT .K..�G..l!1..........Svs.oi�..C. -- .................................................. ..... ........................... Foundation has permission to erect......................................... buildings on ..f�'.�. !.� ........l !�1.' ....... . Rough to be occupied as................. .... - ...... i�a A.:.T�-'.�.�.C..................":.........�.......................... Chimney e provided that the person ac epting this permit shall in every respect conform to the terms of the application on file in - Final 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 1 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC TARTS Rough Service ................. ..... ....... ...................... .......................... ............. ................. BUILDING. ..INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do- Not Remove Final No Lathing or Dry Wall To Be Done FIREDEPARTMENT Until Inspected and Approved by the Building Inspector. TBurner Street No. SEE REVERSE S1 D E smoke Det. NpRTFI TO" Of oAndover .. . No. , Akio l tLAKE o . dover, Mass., COCKICKEWICK V� ADRATED S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 1 — 1 BUILDING INSPECTOR THIS CERTIFIES THAT............. ......... .......................................................... Foundation has permission to erect.......................................... buildings on ..1�'�....�........ .......1. ..... Rough �� ^ Chimney to be occupied as.................. .......... ................. .............:. r. .P. ............................................................... provided that the person ac opting this permit shall in every respect conform to the terms of the application on file in Final 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 1 PERMIT EXPIRES IN 6 MONTHS 0� ELECTRICAL INSPECTOR UNLESS CONSTRUC TARTS Rough ................. ................................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det. Location V •�—"' _ 1 No. Date NORTp TOWN OF NORTH ANDOVER a 3 � P + s • > ; . Certificate of Occupancy $ s�CMUs Building/Frame Permit Fee Foundation Permit Fee $ l Other Permit Fee $ TOTAL $ Check # 24 � '/ � Building Inspector V /• 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 wwwmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Phone #: 860-753-0452 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).` have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.E]Roof repairs. insurance required.] t employees. [No workers' 13.0 Other Rep 6c ,ems comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. klp'Yt t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ace American Insurance Company / Phone:866-283-7122 Policy#or Self-ins. Lic. #: WLRC46138211 Expiration Date: 08/01/2011 Ur Job Site Address: E4_r� C1 City/State/Zip: — i Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der a pains an enalties of perjury that the information provided above is true and correct. Si tune: {Sears Auth.Agent} Date: 1 ) Phone#: Home—Fax: 860-315-7468 / Cell: 860-753-0452 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: i — Ofce of onsunne �11 'ajii&fi s r H} 10 Park- .Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor kelgistr-ation. Registration: 148607 Type: Supplement Card SEARS HOME.IMPROVEMENT PRODUCT Expiration: 10/11!2011 LUSOS SVEC 1024 FLORIDA CENT�Af_ PKWY LONGWOOD, FL 32750 Update Address and return card,dark reason for change, '± Address Renewal Employment I ast(;ard r)PS-CAI 0 50.M-04.104•G101216 rJ,fit( Q7Ntt I3w.....YL[/( [ f((�"i+(IfYIIIl W Office.Dt'Cowsuiner(fairs&Bi Jiji*cs/Rct.u lotion License or registration valid for individul use only ?HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: rGe Office of Consumer Affairs:inel Business Regulation tx ipa Registration: 148607. 14 Park 1'lara-Suite 5170 iration:Ex ` p 10!11!2011 Briton,MA 02116 Type: Supplement Cafd SEARS HOME IMPROVEMENT PRODUCTS ING, r � WBOS SVEC 1024 FLORIDA CENTRAL PKWY �'— LONGWOOf}.FL 32750 Vndercccrefary Int vain!wit liout si nature I � Massachusetts- Department of'Public Safetl 4Board of Building-, Re--nulations 1111d Standards Construction Supervisor License License: CS 97519 LUBOS SVEC 827 THOMPSON F ')AD THOMPSON, CT 06277 Expiration: 8/31/2012 ("umnei�.iuncr Tr#: 2442 "` Illlllflllgllll Proposal Date Jobe ( g Wars Home fm Customer Name __ prtivement Products,Inc. .0.Box 522290 024 Florida Central Parkway Customer's Home Phone Customer's Work Phone Ongwood,FL 32752-2290 p Home Improvement Products hone (800)469-4663 Street Address ESTIMATE AND PROPOSAL ontractor License/Registration Number °p carktimRemodeling IC#148607;all plumbing and electrical Kitchen R City State zip code ervices performed by licensed subcontractors my myminz MA o Is installation within city limits? IN 25-1698591 Installation Address County ❑Yes ❑No Billing Address(if different from above) City State Zip Code roject Consultant Name&License No.(it applicable) !�K LV Description of the Project and Description of the Significant Materials to be Used at it Equipment to be installed The work to be done under this contract includes the following: 1. Professional blueprinting and design confirmation;installation of new cabinets per contract and sign layout.. Customer approved 2. Removal of existing cabinets,countertops,plumbing and appliances where new cabinets are to a installed. diagram of cabinet boxes 3. Minor drywall repair as necessary for cabinet installation(Tape,mud and sand only;no texture atching.) design layout is attached 4. Installation of all moldings and finish trims around cabinet boxes as specified in this contract. to and made a part of 5. Installation of hardware and accessories as specified in this contract. this contract. 6. Installation of sinks,faucets and wall out plumbing when new countertop is purchased with ord r. 7. Installation of electric changes and/or upgrades as specified in this contract. 8. Re-installation of existing appliances and hook up of new appliances as specified in this contra c. Installation also includes the fallowing OPTIONAL features(where checked) Cabinets Countertops olid Surfa a 1:1 Laminate ❑None Door Style: All Square/Combo:(circle one) Brand (Backsplash Up to 41/2"included) Wood Species: Finish: Color MOl�t1 'D Color# Glaze/Highlights ❑ Edge Profile Construction Type: ❑Select ❑Ply Select ❑Other c pas ec a at app y Cabinet Ends ❑Veneer end panels 11 Decorative end panels ❑None ❑0e r 4-1/2"-S' ver 8"-20" ❑20'+ Hardware ❑Coved ❑B -Jointed ❑Tile Door Hdw.# Drawer Hdw.# Sink New ❑R&R ❑Customer Providing Accessories Color S - Model# Holes ❑Appliance Center ❑Pantry Rollout Kit ❑Tilt Tray ❑Disposal Model# Lotion Soap Dispenser ❑Corbel ❑Pantry Shelves Kit ❑Valance Temporary Sink: ❑Yes B-6 ❑Solid Glass Door ❑Roll Tray ❑Waste Basket Faucet B-New ❑R&R ❑Customer Providing ❑Mullion Door w/Glass ❑Spice Rack ❑What Not Shelf Calor IgftSt> Model# Molding Tear-out N C%Trlto ❑Backs lash ❑Crown ❑Quarter Round ❑Light Rail arm BonnO �erS Yes Lineal Feet ❑Full Overlay Crown ❑Base Shoe ❑Rope LightingLPendant ❑Insert Crown ❑Outside Comer ❑Dentil O Flooring Yes ❑Cove El Other: ❑Traditional Appliances rktlre If"Yes'Flooring Add ndu is made a part of and incorporated into this Range A �D txxle next to each appliance(S Below)' contract by reference. Customer(s)initials g FridSe Oven Plumbing 11 None Electrical 11 None Micro /U g Cook Top 1:1 Drop Waste Line D�-__1� Washer Dryer_r'� p 13 New Outlet ❑Electric Line 'Codes Legend ❑Supply/Extend Waste Li e ❑GFI Outlets ❑Subpanel Box INA Install new appliance in existing location. ❑Gas Line ❑Additional Breakers R&R Remove&reinstall existing appliance in existing location. ❑Ice Line Cl 2000 Amp Upgrade P&E New/additional plumbing and/or electrical needed. ❑Misc. ❑2 circuit upgrade NA Not Applicable ❑Misc. Additional work to be done: ate tt S W OI�T V gr–tj Work NOT to be done: Removal or moving of any walls;flooring,painting,wallpaper work;repai rs of water or termite damage to sub-floors or walls;electrical or plumbing work outside of this kitchen or bath project. SPECIAL INSTRUCT!ONS: -•b�. �—ro_��I�u� j� L All of the above check boxes and the"Work NOT to be done"section have been reviewed and explained t me. Customer(s)initials APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximate y v 9EV.* (Approximate Start Date)and will be substantially completed by approximately I (Approximate Completion Date).These dates are subject to Change at the time the contract is accepted by Sears Home Improvement Products,Inc.("Sears")or at any other ime by mutual written agreement.Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prk r pr' to this date to schedule the actual start date. The TOTAL PRICE including all labor,material,taxes and any applicable discount is 10000.-0 Contract Price Initial Payment(not to exceed 3Q%of Total Price unless Special Order $ $ Final Payment balance p ) State Sales Tax(i%) $ Y ( payable upon completion of job) $ Cpo. Local Sales Tax(_%) $ The Initial Payment is due prior to Sears ordering products. The form and method by which the Customers wig tai Amoant Due : () pay is described in a separate Cash/Credit Card Payme Addendum made a part of and incorporated into this contract by reference. Customer(s)initials NOTICE TO BUYER:YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO I 1IONIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA,FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 5 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THI 3 RIGHT. Additional provisions of this contract are stated on the pages following. SKl-MA-Et-W09 Customer(s)initials.. .. '� Ilillllfllllll>I ADDITIONAL PROVISIONS Pr000Sa1 r 1. Sears offers to furnish the materials and arrange for their delivery and install tion as specitied on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be appro ed by the Installation Department.If this is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Departme .If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payment you have made will be refunded to you. Any materials left over after the installation has been completed are Sears property and will be remoi d by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation_ 3ears is not responsible for materials or installation NOT furnished or arranged by Sears.Sears agrees to procure all permits required by loca law. Authorization. I authorize Sears to:(1)arrange for a contractor(licensed where required by law)to m ike the installation of materials;(2)issue a work order for this installation to a contractor;(3)inspect the installation;and(4)pay the contra or when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Inglallation. I agree that Sears is not responsible for delays in delivery or installation due 1 o weather,fire,strikes,war,government regulations or any causes beyond Sears'control. Oral Agreements and Changes in figntra . I understand that there are no oral agreements between ears and me.Everything I expect Sears to do has been included in writing in this contract.Nothing can be changed in this contract unless it i in writing on a separate form accepted by me and Sears. Responsibiliiv of Buyer. I agree that any information or measurements that I give to Sears are corred and complete.l am responsible for any Special work described in this contract. Electrical A Plumbing Servic . I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings.If the electrical and/or plumbing service(s)do not meet the standards of the utility compi iny or electrical and/or plumbing codes, 1 will make the necessarychanges es atm ex ante an 9 Y expense P ss Sears has agreed in this contract to make th changes. Payment. I will pay Sears the cash price that covers the price of material and installation as shown c n the first page. Narranty Information. Appropriate product warranty documents will be given to me by Sears.Sears Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION n addition to any manufacturer warranty extended to you on the product(s)used(which warranty becoi ies effective the date the merchandise is nstafled),if the workmanship(or application)of any Sears'arranged installation proves faulty within o ie year(other),2 years(select),3 years ply-select),then upon notice from you Sears will cause such faults to be Corrected by repair at no additional cost to you.If Sears determines that epair is not commercially practicable or cannot be timely made,then.at Sears'sole discretion,Sears m elect to provide replacement or refund. %ervice under this Limited Warranty is available by calling Sears Home Improvement Products at 1 800-222-5030,Option 4.This warranty lives you specific legal rights,and you may also have other rights that vary from State to State. NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERM k TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TOROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAYOFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TI ,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BU INESS DAY(FIFTH BUSINESS DAY IN ALASKA,FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDERI AFT R THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT.FAILURE TO EXERCISE THIS OPTION, HOWEVER,WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER 131111 MAY POSSESS.IF YOU WISH,YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING 1 HEREBY RESCIND"AND ADDING YOUR I AME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COI IMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY n addition to the Notice to Buyer shown above,Massachusetts law requires that contracts for home improvement work state that all home mprovement contractors and subcontractors shall be registered and that any inquiries about a cot tractor or subcontractor relating to a -egistration should be directed to: Director,Home Improvement Contractor Registration P.O.Box 871 Taunton,MA 02780-0871 Telephone:(508)821-9375 'lease note that owners who secure their own construction-related permits or deal with unregistered cot tractors shall be excluded from access o the Guarantee Fund. dotwithstanding any other language in the contract or associated documents,Sears w II not remove, replace, or install my heating or air conditioning system, or any portion thereof, if asbestos or asbestos containing material is known or ikely to be present in that heating or air conditioning system, or any portion thereof. it is determined or reasonably ;uspected that asbestos is present,either before commencement or during pertormancJnm of the work,it shall be the cus- omer's responsibility to select, retain and pay all costs of a Division of Occupational Se :ontractor to remove all asbestos or verifythat n p ty n("DOS") licensed Asbestos one Is present in the components loved in the)ob.If the determma- ion or reasonable suspicion of the presence of asbestos arises after Sears has starteda work,Sears will immediately ease performing the work until a DOS licensed Asbestos Contractor,hired by the Guster,removes all asbestos from ie components scheduled for repair or replacement in accordance with 310 C.M.R. 70 and 453 C.M.R.6.00 or veri- es that none is present. By signing the contract the customer agrees that it understan the above. 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACE t Customer's signature KYR Dae I f Gust s si to ;epted by Sears Home Improvement Products,Inc.("Sears")on Gt to Aafl, ement r ntative MA-P—09/09 51' 49" - 891 16 38" N 1•fit° i( V I�• °' ` W y i 010 N le7 n 9 25 sn N 16 29 n_ W 16 216 N N - 6611 All dimensions size designations This is an original design and must Designed:6/22/201 given are subject to verification on not be released or copied unless Printed:622/2011 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed.