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Home My WebLink AboutBuilding Permit #282 - 173 COACHMANS LANE 10/11/2006 TOWN OF NORTH ANDOVER p10RTh APPLICATION FOR PLAN EXAMINATION 0* 1US0 #6 gtio 32' a..�'• 6 OL Permit NO: l Date Received N<M Date Issued: - SSACHus�� IMPORTANT: Applicant must complete all items on this page LOCATION / PROPERTY OWNER fz (a (� Print I SSP_ P rO /_ Print V J MAP NO.: PARCEL: 67 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building )(One family ❑Addition ❑ Two or more family ❑Industrial ❑Alteration_--, No. of units: 04�epai replacement 11 Assessory Bldg ❑ Commercial [I Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED C,f4 iaro :7 !A )1r)(4 Identification Please Type or Print Clearly) OWNER: Name: Phone: 41 ,37 3,? Address: 5 t O CONTRACTOR Name: Phone: 7�r- Address: Supervisor's Construction License: Exp. Date: Home Improvement License: /,2(©� Z7 Exp. Date: S- '0e ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ �-/ �v`� FEE:$_ ll Check No.: �C� /a Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ ❑ Tanning/Massage/Body Art ❑ Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ L. Private(septic tank,etc. ❑ Electric Meter location to project - - NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner� Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS _ s FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Siunature&Date Driveway Permit Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use �I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.Jan.2006 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 ork r Wo e s Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses I ❑ 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) 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 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:BPFORM05 Page 4 of 4 NORTH Town of � s _ Andover ,- `. No. 2.82,01 ,- _ ; _ _ �o io LA o dover, Mass., /D oG - COCHICHE. y AORATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... .P ............. .. .f.� .�. ... ................................ Foundation has permission to erect........................................ buildings on ..................../–?„?....ed IC6440 I......ble Rough to be occupied as....... ......... ..��J .......��i��. 80.4 ................... ....................... Chimney C e provided that the person accepting t is 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 53 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LJNLESS CONSTRLJC ON STARTS Rough ..... .. ..... ........ Service ......... ....... ... ......... ... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. w.u�ur, .w , uuvr.�vrIY1 Vldla0IIIn11VUJ•J.`14-:7`J'rJ p,1.14 HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: Branch Name Date: THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Worcester,MA 01607 Branch Number: Job#: �13�(oa3 Toll Free(800)657-5182; Fax:508-756-2859 Federal ID#75-2698460 ME Lic#C 02439 RI Cont.Lic#16427 C T Lice#565522; MA Home Improvement Contractor Reg.#126893 Installation Address: / 3 CCG j n /V n city %& Zip Parch s: A Last 4 Digits of Driver's Lic.#&Exp.Mo/Yr: Work Phone: Home Phone: �(79957 149V 'P[-l9�6$ 37 9� Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): -- Project Information: I/We/You("Purchaser"),the owners of the pro-)erty located at the above installation address,offer to contract with Home Depot U.S.A.,Inc.("He q ot')to furnish,deriver and arrange for the installation of all materials as described on the attached Spec Sheet#Ln139 7:0_-S incorporated herein by reference and made apart hereof Home Depot reserves the right to cancel this contract if,upon re-iuspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with thl:home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval) O 1 Check,Cashiers Check or US Postal Service Money Order CONTRACT AMOUNT $�1 (Made p lyable to The Home Depot). *LESS DEPOSIT $ 1 to r O 2. Credit Card'and/or other payment options-Circle One Below Visa MasterCard Discover mericanExpress BALANCE DUE ^^ ON COMPLETION The home)epot Home Improvement Loan The Home Depot Credit Card $t? 33, O ❑New Accor at ❑Existing Account (HIL&HDCC ONLY) *Minimum 25%of Contract Amount due upon Avatlab.e Credit:S (HIL&HDCC ONLY) execution of this contract 7� 6 D� ! Acct #:_ bHg °n�6Exp.Date:� Name as it api ms on card: R%A co-of F SSE l tom].''et^(� Indicate Payment Method For *By my/our signature below,I/We agree to allow Home Depot to I/ BALANCE DUE ON COMPLETION: chargeabove referen ere card for a deposit indicated./ �— ` tE Cardhold N .:iignare tiatel lei} l/J HIL or HDCC Authorization Codes Deposit Final Payment Purchaser agrees that,immediately upon completion of the work,Purch iser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Aereement:This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCH 4SER Do not sign this contract before you read it. You are entitled to a ,ompletely filled-in copy of the contract at the time ,you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the tontra:t- You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There N ill be a service charge equal to 25%of the contract amount if the job is cancelled by Purchaser AFTER the third busin(ss day. BY MY/OUR SIGNATURE BELOW, I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. VWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AVD TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION, BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME AEF OT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPEN EN DIT REPORTING AGENT;Y AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVER=STONS OR ERRORS. SUBMITTED BY: Date:1 D A710/I Co Iran ACCEPTED BY: _ Date: Homeowner Date: Homeowner NOTICE:ADDITIONAL TERMS AND CONDITIONS/tRE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 7-18-06 CSC White—Branch File Yellow—customer Pink—Sales Consultant MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER ATL-000915907-11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA.INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2594 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE MAYA MCCLURE(404)995-3206 OR AFFORDED BY THE POLICIES DESCRIBED HEREIN. TAMI ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA.GA 30305 COMPANY 100492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY INSURED COMPANY THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY DBA THE HOME DEPOTAT-HOME SERVICES.INC. HOME DEPOT USA.INC. COMPANY 2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY BUILDING C-8 ATLANTA.GA 30339 COMPANY D AMERICAN HOME ASSURANCE COMPANY COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 3 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DDIYY) DATE(MMIDD/YY) A GENERAL LIABILITY IPR 3757 608-01 03101/06 03/01/07 GENERAL AGGREGATE $ 4.000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000.000 CLAIMS MADE Fx—]OCCUR 'OF SIR:$1.000.000 PER OCC' PERSONAL&ADV INJURY $ 4.000.000 C WNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 RRE DAMAGE(Any one fire) $ 1.000.000 MED EXP(Any oneperson) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03 AOS 03/01/06 03/01/07 COMBINED SINGLE LIMIT $ 1.000.000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident X ELF-INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ G WORKERS COMPENSATION AND 6610998 AZ.ID.MD.VA WC STA OT EMPLOYERS'LIABILITY ( ) 03/01/D6 03101/07 X TORY LIMITS ER C 6610995(AOS) 03/01/06 03/01/07 EL EACH ACCIDENT $ 1.000.000 G THE PROPRIETOR/ - X INCL 6611326(OR) 03/01/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1.000,000 PARTNERS/EXECUTIVE E OFFICERS ARE: EXCL 6610999(NY.W Q 03/01/06 03/01/07 EL DISEASE-EACH EMPLOYEE $ 1,000.000 OTHER WORKERS E COMPENSATION CONTINUED 16610997(FL) 103/01/06 103/01/07 D 6610996(CA) 03/01/06 03/01/07 DESCRIPTION OF OPERATIONSILOCATiONS(VEHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL_ n DAYS WRITTEN NOTICE TO THE FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: Walter Gilstrap :� 4-a-A MM1(3102) VALID AS OF: 02/27/06 AT-HOME Installed Siding and Windows .♦ f.'. ei.f:lll Y!/�,.1!!i'.i%%/.' !l . ((lfJ.i(r('1!(f�r:(,,: r 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: 126893 Board of Building Regulations and Standards Expiration: 8/3/2008 One Ashburton Place Rm 1301 Type: Supplement Card Boston,Ma.02108 THE Horne Depot At-Home Servic AUNROEUN CHHOUY 3200 COBB GALLERIA PKWY#20 AtIANTA,GA 30339 --- `�-- g Administrator Not valid without signature I Proudly gold,furnished and installed by RMA Home Services,Inc.,a Home Depot authorized contactor. 345 Greenwood St,Unit 2•Worcester, MA 01607•508-756-6686•Fax 508-756-2859•Toll Free 3004657-5182