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Building Permit #214 - 167 DUNCAN DRIVE 9/18/2007
pORTH BUILDING PERMIT 0 TOWN OF NORTH ANDOVER 0 p APPLICATION�FC t PLAN EXAMINATION Al Permit NO: Date Received 7 7 �gATe° c5 �SSACHU`��� Date Issued: r `U IMPORTANT Applicant must complete all items on this page 1'RCtI'ER Y C W�NE122 x k 4 �3 A P .- s✓r Y4 f� i'it } 4 MAPO PARE h " Z©NII ''DISTRICT"H1ttiC"# fst)fCY yeS t10 St10 V"11e1ge = ,yeS3 achfne o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Mne family 7Addition ❑ Two or more family El Industrial ❑ Alteration No. of units: 11 Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition El Other - 11.11S� ttclNe1t Fcoc�lari IWetlands 77F WaterlledDstrtct m "S' DESCRIPTION OF WORK TO BE PREFORMED: 0 w I")-_� Sl P9rs 0000-i 9-b q--rIST /''? 1JeG1, fE I Roo t-- o ;:� -C.oJ Z 2-(f 0 (o4) Identification Please Type or Print Clearly) e((!'�l OWNER: Name: rA►Y.ZL A— Phone: 87z Address: �ONTRATRNam �' � f�: ,Y� S p orte � AddressC � '„ SupervlsiaT's rons#ructann Licen se "/` Horne Improvement iA-lce.nse �" ,..,vExp TDate t r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.+r$12.00 PER$$11000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I / V FEE: $ q Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of AgentlOWnertl "'" -- r�nature vof cantracto 1 ,. . Location (� "! Do /2 Dlv No. Date f H°RTM TOWN OF NORTH ANDOVER � D ` Certificate of Occupancy $ Building/Frame Permit Fee $ J IT cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I 206 _ Building Inspector 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 REJECTED DATE APPROVED ONSERVATION COMMENTS On �lil!AGI w(k [�;"c (Ai�(Vlo( tjpourwlv�—A �yJj�-1 ����Z���r� v� DATE REJECTED DAT M PROVED HEALTH /y/�, . , ❑ ❑ �Z p 7 COMMENTS4/:5 r / ( -r/I✓D Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature & Date Located at 384 Osgood Street Driveway Permit FIRE DEPARTIIrIENT Temp Durpstet nn site es v Located at 124.Main Street:; „ Y no rFtre DepaA. rfiment signature%date ti a . 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 NOTES and DATA— (For department use ❑ Notified for pickup - Date ..........................................................._..........................................................................................................._......................................_....................._... Doc.Building Permit Revised 2007 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 ❑ Building Permit Application o Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 TA T►y Town of : Andover No. o doer, MaLAK ss.tl- 14f ISO COCHICHEWICK ORATED BOARD OF HEALTH Food/Kitchen PERM- IT T D Septic System C �� BUILDING INSPECTOR THISCERTIFIES THAT............. . ........... ... .. ........................................................................... •...••...•................. Foundation ................ buildings onA.... 1 �0.0 Rough has permission to erect........................ .. ... .........ftih6e v .. .. .. .... to be occupied as....1� � ... �I ..........&...� 0....op. d.�. .. .... Chimney C e provided that the person accepting this permit shall in every respect conformerms 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 PERMIT EXPIRES IN. 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough -S............................................................................. Service BUILDING INSPECTOR 4- 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. ALL HOUSEPLATES ARE TO BE SUPPORTED BY 4'x6"OR 6'x6' TRIPLE LAMINATED POSTS AT THE HOUSE OR BY A DOUBLE 2"x10"CANTELEVER SYSTEM OFFSET FOM HOUSE.DEPENDING UPON FIELD CONDITIONS. (SEE DETAIL ) 2"x10-HOUSE PLATE 3/8x4'DOUBLE HOT pPPED GALVANIZED EXISTING TOP PLATE LAG L WASHER 16"oc 1/2"EXISTING SHEETINGTIN 2'x4'LEDGER GIRDER BEAM tO KIA&S 5 ppRR b HOUSEPLATE 3/8'EXISTING SIDING BAR 1 A1NA Ot� Q B ATTACHMENT 3/8"x4-DOUBLE HOT OIPPE EXISTNG 2'x4' RAILING TO BE CONNECTED T GALVANIZED LAG PLATE 3/8"DOUBLE HOT DIPPED 6' 6• "OUSE USING A Ue:a"LAG I xi Ktn GALVANIZED WASHERS EXISTING SILL PLATE 3/8"x6"DOUBLE HOT DIPPED SIDE BAND 3/8x6'DOUBLE OPPEO HOT DECKING GALVANIZED LAG HOUSE BAND IS NOT TO SUPPORT GALVANIZED LAG L WASHER IS 16'oc COMPLETEDECK DETAILS GALVANIZED DOUBLE HOT DIPPED ANY OTHER LOAD OTHER THAN ITS' GALVANIZED LAG OWN WEIGHT. THE LAG PENETRATION 2-x4-LEDGER ONE LAG SPACING IS ONE t'LAG AND NYL FLASHING ON INTO EXISTING HOUSE BAND WILL BE TOP DA MOUSE PLATE A MINIMUM OF 1-3/4-AND A MAXIMUM ONE 6-LAG ON EACH END OF THE 2'x10"MUSE PLATE OF 3". ALL LAG BOLTS TO BE HOUSE PLATE AND THEN ONE t'LAG AND ONE 6-LAG EVERY 116-ccINSTALLED USING AN ELECTRICAL saatr EXISTING CONCRETE IMPACT WRENCH WITH A MIN.TORQUE FOUNDATION OF I1OFT.-LBSI� RAILING P DETAILS 5 2NUI IUbLA 21NI1906LIVEMIF SK OIT LL 8 K POST DETAILS TRUSS PLATES SPACED APPROX.EVERY W oc sa Nnas TYPICAL FRAMING MEMBER CANTELEVER AND EXISTING DECK I &J POST DETAILS 20 GAUGE GALVANIZED Alsototr 1pp1 x ��TRRgIPLLLE HOT--E�� S/4-x6-SCREWED TO LINOERSTRUCTURE TRUSS PLATE INSTALLED UNDERSTRUCTURE 10 AUGE TRUSS PIAT S SCREWS WITH 1213 WLVAN2ED WITH 10 TON PRESS D L F DETAILS U0 G TT E SCREWS EVERY M oc. N BO H SIDES OF NOTCH 2 x10-NOTCHED 1/11-WATER r: ON BOTH ENDS DRAINAGE GAP MOUSE PLATE POOL NOTCHED BEAMS FORM A WOOD ON WOOD CONNECTION WITH THE 2'x4-LEDGERS OF CONNECTING BEAMS. (813-GALVANIZED SCREW SHANK NAILS TO BE TOE-NAILED INTO EACH CONNECTING BEAK MOUSEPLATE OR SU OITA& FRONT BAND ror GIRDER BEAM s1l.l.r DECKING SPACED APPROX MAY NOTE--SEE OETAIL(9)FOR, -oc. (� 2-x4-LEDGER 04AX JOIST SPAN 16•-0-1 Q DETAILS (1)POST AND FOOTER LAYOUT rs10-FRONT BAND (2)FRAMING AND UNOERSTRUCTURE LAYOUT WITH 2'x4-LEDGER 2-00-SIDE RANO (3)RAILING LAYOUT �FRAMING/UNDERSTRUCTURE CONNECTION DETAIL CONTAINS TRUSS PLATES CONTAwS TRUSS PLATES NUT TU SEALE 1 DESM EXCEEDS GM LIVE LOAD ONONESIDEEpONLY� ON ONE SIDE ONLY (4)STAIR LAYOUT LATERALLY BETWEEN POST �ZISOMETRIC DRAWING NU I I U t)LALE %ESI N EXCEEDS 6 Ib.LIVE LOAD OOLL GAEEU GA VANII D TRUSS BANO.OR CROSS JAOMISTIOE GWONG OVIEFUHN ER BEAM�Np(�NNSTALLEO H IN WITH DE11=00gDLiNk11IMLOAD ITH A 10 TON PRESS. Z NOT TO SCALE 0 DESIGNER DECK US MREMDOEELERS DECKS ENCLOS ESSPEC GAZEBO T OS ARENOTPACKAINTEE ISNDED DED TOSIRED SUPPORT FOR TITUBS AND NOTE: FRAMING LUMBER TO BE SOUTHERN IMMING/BABAL SUPPORT BEFORE ADDING THESE TYPES OR PRODUCTS OR ANY OTHER HEAVY UNITS PINE NO.1 EXCEPT FOR ALL STRUCTURALTS 16'MAXIIUM LENGTH MEMBERS SPANNING OVER 8'-0"ARE TO BE SELECT STRUCTURAL WITH Fb=2050 PSI. LUMBER IS TREATED WITH PRESSURE TREATED F SURE ASSEMBLY NON-ARSENIC BASED PRESERVATIVE TO 1 0 DESL91EXCEEDS GMLIVE LOAD THE REQUIREMENTS OF AWPA C2-92. ND-TL.-2000 lb.SOIL BEARING COMPACITY SEE DETAIL�AND QDFOR POST rxto'SIOEBAND PLATEHDUSE X-BRACING TO BE USED IN DECKS TREATED LUMBER BELOW GRADE WILL BE.-0. CONNECTION 0 STRUCTURE. 2-x10- BTAIL®) A.60 OR GREATER RETENTION LEVEL SEE DE YX10'FRONT BAND (tl 3'NAILS,TOE- FRONT BAND HALED IN CANTELEVER BEAK 3/8"xt-DOUBLE HOT DIPPED GALVANIZED 2"x6"BACK LACK AND LAG WITH WASHER THE NAL PATTERN CONNEZCTOG A6Li6" Z s4 LEDGER `jH OF AJq�y IS TO BE 3 NAILS roc DECK POST TO DECK THE POST FORMS arc,P INTO THE INNER JACK HOT x6-DOUBIE UNDERSTRUL I URE 3/8'14-DOUBLE HOT A WOOD IO WOOD WITH civ nti DIPPED GALVANIZED CONNECTION WITH WL AV NI"D FOUR 3-GALVANIZED LAG WITH WASHER THE UNOERSTRUCTURE. 2-x6"FACE LACK PLATED LAGS SCREW SHANK NAILS AND(2)r NAILS g Y Ay T ANO WAI, RS SPACED EVERY it oc. CONJECTNG 6"x6" 6-s- T? 6-1 o A y CANTELEVER SUPPORT• TWO 2-x101 INOERS- DECK TRUCTURET TO K 7 of MTEAXID�MNMO�LATERAL .AB wuE AI NWKR U �' A HALED WITH 2 NALS CANTELEVER BEAM POST SPA C0�OUT S E E L E Y 982516 N "7 EVERY 6-a TOTAL OF 10 ALL LUMBER W/GROUND 2-:s'INNER JACK PST PER SUPPORT)INTO gt�r��Mt CONTACT OR TREAT RATED °ERIRT NUMBER DATE GR�pE RETENTION LEVEL 08-18-07 THE NAL PATTERN 167 DUNCAN DR NORTH ANDOVER a _p IS TO BE 3 NAILS LA&TRPI 2 j6-I FOOTING(FACCTORY FOOTING(FCTORY TREET CIri /QNP.t E� V 8'oc INTO FACE JACK k�oo� TED POS MUM PRECAST @1U�3000 P.S.I. PRECAST 03000 P.S.I. cuum. IL POS�SPACING UNDERCONTROLLED UNDERCONTROLLED ESSEX MA 01845 CONDITIONS) CONDITIONS) SIGNDRAWN BY ICC LE Y REPOMT B 116'X6"(TRIPLE 2"01 POST CONSTRUCTION OF QM K 6'x6' VECTOR SOLUTIONS 93-52.01 1 NOT TO SCALE LtCEIDSO .LMILaAD 1 TTOSCALE ExtID1056�,LIELOAO 1 ExoEL�s18sL3vEtcAD DECK DIVISION FOR HOME DEPOT PAGE 1 OF 2 1041 CANNONS COURT WDODBR[DGE, VA 22191 OrnPYRIGHT 2000 US REMODELFRS INC HORIZONTAL STARTING POINT VERTICAL STARTING POINT TIGHT UNDER DOOR LEFT INSIDE CORNER OF HOUSE THE RAIL POST ASSEMBLES ARE TO BE SPACED AT 70"oc MAXIMUM 2'x4-RAIL CAP ON DECK PERIMETER BAND. NAILED WITH 2 NAILS N EACH POST AND 1 NAIL EVERY 12-ac INTO Yat-RAILCAP 2"AY PICKETS r:4-RAIL POST TOP RAILING PLATE_ rxl-RAIL PLATE NAILED WITH 3 NAILS N A TRIANGULAR FORM INTO 8" E RAILING INTO EACH RAILING POST. Yx4-RAIL PLATE D6 N ISEEDETAIL©1 HALE POST)ACK NAILED WITH 2 NAILS EVERY 1 Q J (TOTAL OF 6 NAILS PER POST JACK)INTO EACH RAILING POST. HALE RAIL POST O NAILED WITH 2 NAILS EVERY rot (TOTAL OF B NAILS PER POST) INTO THE PERIMETER 2%10-DECKFn 2-x10-DECK BAND IRWERSTRUCTURE ' YAl-POST I APPROX_48" �, APPROX.48- T SUPPORT wPO 6'-L•RA0.1N 2-x4-POST SUPPORT (SEE DETAIL Pl) NAILED WITH 2 NAILS EVERY 3/0"xt-AND 3/8"x6" BATF-RAILOD TO BE WOOD. 2"Ar PICKETS SPACED LESS THAN 6-ac(TOTAL OF 6 NAILS PER DOUBLE HOT OPPED RAIL CAPS TO MATCH t'APART.AND NAILED WITH 1212-1/2 POST SUPPORT)INTO RAIL PDST. GALVANIZE D PLATED LAGS oeau+0 STYLE. GALVANIZED RING SHAMMED NAILS WASHER CONNECTING 2-x1- PER 2"d'RAIL PLATE. RAIL POST TO FRONT BAND 16'RAIL HALO'DECK BAND TRADITIONAL RAILING DETAILS (SEE DETAIL Pl) 16, BRACES(REF TO)RUN DIAGONALLY 1 TTO DEMCCOID4tNLLl1Y[LOAD FROM THE CANTILEVER TO THE APPROXIMATE ELEVATION 102- FRONT BAND. THE WIND BRACES ARE TO BE NAILED INTO THE BOTTOM EDGE OF EACH OVERLAPPING MEMBER WITH THREE 3"GALVANIZED SCREW SHANK NAILS. VINYL FLASHING TO BE USED WHEN APPLICABLE TO CHANNEL EXISTING DECK WATER AWAY FROM HOUSE. zx10 PER1RTER 2x10 PO TM 2)10 PEWTER BAro BAND BAND 24l 2X4 UIDGER 4jel- iw'eoLTs `GIC, llu'Ba °-"Ts' �t.� LAG BMT S2XS SS��\` 2x0 T SEE DETAIL l O POOL STAIRWAY i0 GRADE (�.ONE Or THESE OPTIONS WILL BE USED FOR ALL STAIRS ON BOTH SIDES WHERE STRINGER ATTACHES TO DECK (SEE DETAIL01 GRASPABLE HANDRAIL TO CONSIST OF A rx2-PICKET MOUNTED BETWEEN 34--38'FROM THE STRINGER WITH STAR PAD K TO BE SET LEVEL ON THE HANDRAIL BRACKETS EVERY W. TOP AMC BOTTOM OF GROUND AND NAILED INTO EACH STRINGER HANDRAIL IS TO TURN BACK INTO RAIL PLATE. WITH 6 NAILS 3/8-x6-LAG BOLT TO ATTACH EACH STRINGER TO DECK S/1-x4-DECKING 2-x1-RAILING CAP IS TO BE NAILED INTO EACH POST WITH 3-NAILS AND NAILED INTO HALE BAND THE TOP RAILING PLATE WITH rat-TOP ONE NAIL EVERY 10-oc RAIL PLATE Y POST/ FOOTER FRAMING/ UND RSTRU TUR RAILING. AND STAIR LOCATION Z-xW KICKPLATE \,VNOT TO SCALE DECK DESIGN EXCEEDS 401b.LIVE LOAD rx4-eo7roM rxtr TREAD RAR PLATE WOW' NAILER STARS HAVE 11-s/8"TREADS WITH 7-S/8' 9 RISERS EACH TREAD IS FASTENED TO THE STRINGERS WITH 3-NAILS 2"xt-RAILING POST N EACH END. THE STAR RAILING POSTS ARE W�ITH'RpPED TE.STEP YX70-AS TO BE WRAPPED NAILED INTO THE STRINGER WITH NECESSARY PER FIELD CONDITIONS NAILS,AND NTD BOTH THE RAIL rxt'TREAD CLEATS PLATES WITH 3 NAILS EACH. TREADS ARE SUPPORTED BYNUT To rxl-CLEATS WHICH ARE TOYx1Y STRINGER 4 BE ATTACHED TO THE STRINGERS WITH 3-NAILS AND 121 3/8" THE STARCASE IS TO HAVE(21 2"x1H x 2-1/2'LAGS PER CLEAT. STRINGERS.ONE ON EACH SIDE.EACM STRINGER IS TO BE TOE-MAILED INTO THE DECK WITH 3"NAILS AND INTO THE IILL{�� STARPAO WITH r NAILS. L x I (TRIPLE POST THIS SPACE NOTE I ER CCUWRRENTLCOOEI T rA1r sTRNGER 2-AID-TREAD LAMINATED POST Har RAILING PICKETS 3/8 xt DOUBLE IDTKPLATE SPACED LESS THAN 4-APART AND DIPPED GALVANIZED NAILED WITH(2)2-VY NAILS PER PLATED LAG BOLT STAR PA0 2-x4'RAIL PLATE rxt-CLEAT READY MIX CONCRETE (SEEOETAIL®1 a��LSN DF M4ss4 HAl-BACKER PLATE 4'x6'PO5T 13 LAMINATED y POUREDMINIMUM OF 4" r NO.IGRA SOE 2 x4') IF I , ac; 8"x15"CONCRETE MINIMUM OF 3000 s.i. L E LEFT BLANK TO THE RAILING ST warm D 8-xiS-CONCRETE FOOTING �.�i P TO THE RAILING POST WITH D NAILS. 'a FOOTING (FACTORY MID THE RAIL PLATES WITH rNAILS. (FACTORYPiECASTpp3000 o A`,AA PRECAST (1D3000 P.S.I. AND NTOTHE STRNGERWITH3'NAI.s P.SIUIDERCONTROLLEO A! • AS s UNDER CONTROLLED CONDITIONS) 7 'x6"TRIPLE N� 4273. CONDITIONS) AMINATED T �STAIB�P$OST AND FOOTER DETAIL i8• .0Ar, _ INTENTIONALLY Q G, � ti FOOTER SEE GEETAIL®D ) Q_STAIR DETAILS UP TO W-8•ELEVATION&48•WIDE.WITH EXTENDED PAD GNAL Z OUBLETOST F 13 NOT TO SCALE 01�11118M=GM LNE LOAD 2 NOT TO SCALE EXCEEDS 601b.LIVE LOAD JOB MAW PESIMIT NUMBER SEELEY 982514 1 ECK DIVISION FOR HOME DEP❑ 1041 CANNONS ADURT PAGE 2 OF 2 OCOPYRIGHT 2000 US REMOOELERS INC. f C l,•t,� i�1t E + CUStOmer'S Last Name,First Name I Store No. Y" Order No. ervlce Address --- -- ___ Zip - billing/Mailing Address(If different from Service Address) City 7110 _— State Z,p Customer's Daytime Tel.No. Customer's Evening Tel.No. V S Customer's Driver's License No.or State Identification No./t CUSTOMER'S INITIALS: BY INITIALING,YOU AGREEE THAT BY YOUR SIGNATURE BELOW,HOME DEPOT,ITS AFFILIATES,OR AN AUTHORIZED REPRESENTATIVE MAY COf:TA.0"r YOIj I BY PHONE,FAX OR E-MAIL ABOUT OTHER SERVICES THAT MAY BE OF INTEREST TO YOU.YOU MAY ALWAYS CHANGE YOUR MIND LATER;JUST LET US KNO'N. Primary Payment Method: ❑Checki'Money Order ome Depot Card/Home t 3 3�c LT Imp_rovem_ent Loan ❑AMEX ]Discover ❑MasterCard-❑l VISA Account Number: �`() U Expiration: / Secondary Payment Method:❑Check/Money Order ❑Home Depot Card/Home Improvement Loan ❑AMEX \` Secondary Account Number: []Discover ❑MasterCard [_)VISA v Pa ment Schedule_You agree Yourpayments will become due on Expiration: / -- be automatically charged or debited(as applicable)to Your designated accoul t(s)aw when due.ow if You are paying other than by check or money order,may Down Payment: Final Payment: Due immediately.Your down payment is NOT an installment payment under t is Sales Tax: Agreement. $ _ Due on finish date(see below)of installation. $ _ If applicable. k4kl b Total Amount of Sale: �ru/ /tt�bates�o Includes all applicable discouand taxes.Excludes finance charges.' Any interest payments or other finance charges will be determined by your separate cardholder or loan agreement,to which Home Depot is NOT a party.Please sec this Agreement's General Terms and Conditions for more details as to other charges that may apply. Anftippte-c InstallgtiCL Schedule Please note:Nelther The Home Depot nor Installation Professional are responsible for starUfinish delays resulting from even;; beyond their control including.but not limited to,Change Orders,acts of nature,governmental actions,manufacturing delays i i IS'anDate: / _ damage to merchandise cause by third parties,labor strikes,%unrest,Your credit'tinan i -/+1•i legal encumbrances on Yourproperty, c ng,any incorrect in You provide. I 1 �!C� hidtleruunforeseen physical/ azrdous conditions(inc!udinonC g but not limionformance ted toth ner9-ironme tan harequirements or building code requ,rements Finish Date:.__ ;— and lin ead paint)at Your service address or Your noncompliance with this Agreement.The Home Depot reserved the rightos terminate this agreem_ ent an d1or require Installation professional to discontinue Installation given any of the foregoing condionto s. Definitions:"You"P'Your'"means the customer identified above."Installation"means the installation services specified in this Agreement."Installation Professional"or"Professional"means an independent contractor authorized by Home Depot(licensed and insured as required by Home Depot and applicable law)and the contractor's employees,agents and subcontractors."Agreement"means this Special Services/Home Improvement Agreement between You and Home Depot U.S.A.,Inc.(interchangeably referred to as"Home Depot"or"EXPO Design Center"),which includes this page;the General Terms and Conditions following this page,the State Supplement,the Invoice or Specifications and any other documents expressly made a part of this Agreement.Please see this Agreement's General Terms and Conditions for additional definitions. Acceptance and Authgrization:By signing below,You authorize Home Depot to(a)arrange for Installation Professional to perform Installation and' or(b)order and arrange for the delivery of special order merchandise,including special order merchandise that may be custom made,as specified in this Agreement.You understand this Agreement constitutes the entire understanding between You and Home Depot and may only be amended by a Change Order signed by Hoole Depot(or by Installation Professional or its authorized representative on Home Depot's behalf)and You.This Agreement expressly supersedes all prior written or verbal agreements or representations made by Home Depot.Installation Professional,You,of anyone else.Except as set forth in this Agreement,You agree there are no oral or written representations or inducements,express or implied,in any way conditioning this Agreement, and You expressly disclaim their existence. Do npt sign if blank or incomplete.(Installation Professional's/ permitting information may need to be provided to You later.)By signing, You acknowledge that You have read, understand, and accept this Agreement i itsentirety.Y000Purthgr,acknowledge receiving a complete copy.Keep it to protect Your legal rights. Accepted by. ll r � X - � L Profes&.onal:FUII .i.ezTrade _ `.� N me.. es_aryJ Lh2^s;. r:r No,. ' �J+=T-�% -fes."t/` C�s!omer's InBials�j_ - _ BY INITIALING,YOU AUTHORIZE DELIVERY Ofr_•, TO SERVICE A6QAESS PROVIDED ABOVE WITHOUT OBTAINING DELI ERR AGENT S SiGNATUHE AND ArRFE TO INDEMNIFY AND HOLD HC}f> DEPOT L / 1E DE. T HAHA�ESS FROIV,A.tJ`r RESULTIt,�>CLAI'•fS. _ ` - 1!,`,, . H: ..Gec.c..5a ::'.PRINT Ye FHiP;T'rc: p :r, U N._ , ,�.'F„L'P�,�, ._:;;��;;:,. HOME DEPOT'S LICENSURE INFO:SEE ANNEX ! DISTRIBUTION:While--Home 09 BUYERS RIGHT TO CANCEL:SEE GENERAL TERMS/CONDITION'_ ,r p._ Copy Yellow--Customer Copv Pink- Installation Profecsinnal('n,,, 91te -� Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 123392 Type: Supplement Card Expiration: 2/11/2009 US REMODELERS INC-d.b.a FACELIFTER , DAN FARRELL 405 STATE HIGHWAY 121 BYPASS STE, 2 LEWISVILLE, TX 75067 Update Address and return card.Mark reason for change. DPS-CA1 Co 50M-05/0&PC8490 E] Address E] Renewal F-1 Employment E] Lost Card z71e�om�,zanusealll o�,/�crGeaclzuaetr~v -- Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:'. 123392 Board of Building Regulations and Standards Expiration: 2111Y2009 One Ashburton Place Rm 1301 --Type: Supplement Card Boston,Ma.02108 US REMODELERS INC4d.b.a`FAC GAYTFAWRELL / 405 STATE HIGHWAY 121`BYPAS �Xot EdIV�SV��tE,TX 75067 --""Administrator valid without signature � � ' ✓/ae�anv�na�uve�o�./�laaoac%uvelA BOARD OF BUILDING REGULATION'S License: CONSTRUCTION SUPERVISOR ,.' Number: CS 070960 t' s: Birthdate: 09/25/1966 I:Expiresi 09/25/2007 Tr.no: 4319.0 Restricted:�00'. DANIEL H FARREL'LI-- 101 POPLAR ST TEWKSBURY, MA'01.876. Commissioner h DATE(MM DD YY) A CORD: RTIFIC TE QF LZABI Ifi 5u �� 04/04/07 K PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Aon Risk services, Inc. of Virginia 7325 Beaufont springs Drive AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS Suite 300 CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE Richmond VA 23225 USA COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE-(866) 283-7124 FAx-(866) 430-1035 INSURERS AFFORDING COVERAGE INSURED INSURER A: American Guarantee & Liability Ins Co U.S. Remodelers, Inc. INSURERB: National union Fire Ins Co of Pittsburgh Attn: Stephen Thompson 405 State Highway 121 Bypass INSURER C: American Home Assurance Co. Building A, suite 250 w Lewisville TX 75067 USA INSURER D: C v INSURER E: a COVE RAG . This Cerfificate is notinte0ded to s epi alFendo6emezits coveea' s;.terms'cortditious and exclusions of.the policieg Shown; 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER LIMITS O DATE(MM\DD\YY) DATE(MM\DD\YY) n ry B GENERAL LIABILITY GL1774139 04/02/07 04/02/08 EACH OCCURRENCE $1,000,000 � General Liability ao X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anv one fire $250,000 H CLAIMS MADE OCCUR MED EXP(Any one person) $5,0 0 O PERSONAL&ADV INJURY $7„000,000 GENE RAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS-COMP/OP AGG $2,000,000 O POLICY E ECT- a LOC z a+ R B AUTOMOBILE LIABILITY CA 8262349 04/02/07 04/02/08 COMBINED SINGLE LIMIT u Business Automobile ANY AUTO (Ea accident) $1,000,000 'L X ALL OWNED AUTOS BODILY INJURY C.J SCHEDULED AUTOS (Per Person) X I11RED AUTOS BODILY INJURY X NON OWNED AUTOS (Pcr nccidcnt) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC HAUTO ONLY AGG A EXCESS LIABILITY AUC534554902 04/02/07 04/02/08 EACH OCCURRENCE $10,000,000 umbrella X OCCUR ❑ CLAIMS MADE AGGREGATE $10,000,000 DEDUCTIBLE RETENTION B WORKERS COMPENSATION AND wc7171490 04/02/07 04/02/08 X wC sTATu- OT11- EMPLOYERS'LIABILITY workers Compensation - AOS TORY LIMITS ER B wC7171491 04/02/07 04/02/08 E.L.EACH ACCIDENT $1,000,000 0 Workers Compensation - CA E.L.DISEASE-POLICY LIMIT $1,000,000 C WC7171493 04/02/07 04/02/08 E L.DISEASE-EA EMPLOYEE $1,000,000 workers Compensation - TX 23a OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Cancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the cancellation. CERTIFICA.:; 'HOLDER 5 . CANCELLAtioN For Information Purposes only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,TIIE ISSUING COMPANY WILL ENDEAVORTO MAIL X TX 00000 USA 30 DAYS WRITTEN NOTICE TO TILE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. aa1 AUTHORIZED REPRESENTATIVE >;eat ,1Owwz-", 9asa. a��iF1ttJ.eisert r # The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): `' +"\rry1UtJrLJ7 � N ii Address: f Z 5 r D City/State/Zip: w J�1�30�.,ci-1 I �j '� hone #: J 5� 3 j ) Are you an employer? Check the appropriate box: Type of project(required): L 1�9 I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction part-time).* employees (full and/or p .* have hired the sub-contractors listed on the attached sheet. $ 7• F-1 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. F1 Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition workers'co insurance 5. El We are a corporation and its [No �• officers have.exercised their 10.[] Electrical repairs or additions required.] I Ln r airs or additions 3.El am a homeowner doing all work right of exemption per MGL ❑ Plumbig rep myself. (No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. (No workers' 13.N Other 0rC:-j` comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 is providing workers'compensation insurance for rrcy employees. Below is the.policy and job site information- Insurance Company Name: I�G1'' � Sj Si�tzViL>� /NLS Policy#or Self-ins.Lic. #: p\At � 17 11410 Expiration Date: Job Site Address: City/State/Zip: 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 DIAfor insurance coverdg verification. I do here under the pains es f perj ry that the information provided above is true and correct. Si a <ga �� Date: - Phone# �'� v 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/Towu Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: �y f Information and, Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." I An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors) aame(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no employees,other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised.that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or.town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials i Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permidlicense number which will be used as a reference number. In addition, an applicant that must submit multiple pern it/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 5-26-05 .t..—,—10n —vr1A;n f 0 # . AS - BU LT P-LAN IN: NORTH{ ANQOVER, M/3 i Schle I" s'7o'' caTE O"g) 45 t t TO GcRTiPY ri,A7 - _ TANGnRb HNS r/rO' i DVNCAN LORI VBA N. ANDOVER MA THE &kAD'ES ARE AS w THE PLANS . 666# DATED 512411.r, REV, Gj'?Ojjs E'RB PA ZEO i3Y NETW ENCrLRND I ENe IN EE'R IV(r SE(L VictS SN G. f! y. ELEVRTw Nz SEP7)C TANK 6.r 91.61 S,x IN 4 O�sT. box ov-r 4C..o1 Iu OEn b. N.T eLE b '9 9S.T9 311, E 95. 61 Cl- J, qS.63 �i. t•I 9 S• S 4 .. r _ WSTA1NC Et ro _ ! 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