Loading...
HomeMy WebLinkAboutBuilding Permit #671 - 306 MARBLERIDGE ROAD 5/13/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: �- IMPORTANT: Applicant must complete all items on this pate -tv "4- N Res' rential Non- Residential A 'R P ',OPZRTY. �6' t: Two or more family Industrial - No. of units: 4 yes 41C Repair, replacement Assessory Bldg Others: Demolition TYPE OF IMPROVEMENT PROPOSED USE Res' rential Non- Residential New Building One family Addition Two or more family Industrial ,Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other d "I' -W a, S�" 00 aimle, A'� 'Water h I -,t d 9 rid - e7r �Mbterfbe W, V q or Print Clearly) OWNER: Name: '2"' Address: :SU( ARCHITECT/ENGINEER 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: $ FEE: $ Check No.: CP (� 63 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tolh'e)gq�randfund t 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 ❑ Workers Comp Affidavit ❑ 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 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 o 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 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 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes _ f Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street 3 FIRE DEPARTMENT 1 emp Durrapster on slt �yes�F rib Loca#ed°at,124Mam Sheet r * �� Fire Departinerat ign� WIM-dale } r� 'fir ' a^ssrya Mwr• » 9 x^F ;,+. "`' COMMENTS Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 Location3o& ZJ 'e - 4r No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ MU ---------- Foundation Permit Fee $- Other Permit Fee $ TOTAL $ Check # 03 2 54 Building Inspector 101 �I 0 Ns z o o � c ` r C r' LrC O •nccom O, C :m= • r r oCD C Ea rO.. C :.0 it r V O O. :EE 0 CD c ca Cl m C : N N O .ice A N m _ � h m ., _O _rr.O aCD- CCL C V d! O evv Z ao CDCOD o c m r uiO CW O r C r � r ui .E 5 o v .y Ci cm CLo�� c Z A_ r Sam �E IE h O cm H C O 0 m C: C _ CC 0 cm c C N m t r 0 2C O 8 czF. 2 • • FOP �� L CD O E L ' w Z o, O h D � CD cm i 0 y W •� = m ow co coCJ L !O O Off. Qm Q h C o *-0 c C a cc "EL CD C CD CL V y !O C C H 0 uj 0 LLI W W ce W N o w v v cn ° o w o n: v a U G iw Op a a o c x a w o rw v cx x o c z w i 7 z cn Q E cn 101 �I 0 Ns z o o � c ` r C r' LrC O •nccom O, C :m= • r r oCD C Ea rO.. C :.0 it r V O O. :EE 0 CD c ca Cl m C : N N O .ice A N m _ � h m ., _O _rr.O aCD- CCL C V d! O evv Z ao CDCOD o c m r uiO CW O r C r � r ui .E 5 o v .y Ci cm CLo�� c Z A_ r Sam �E IE h O cm H C O 0 m C: C _ CC 0 cm c C N m t r 0 2C O 8 czF. 2 • • FOP �� L CD O E L ' w Z o, O h D � CD cm i 0 y W •� = m ow co coCJ L !O O Off. Qm Q h C o *-0 c C a cc "EL CD C CD CL V y !O C C H 0 uj 0 LLI W W ce W N May 06 08 07:31a Rick Odonnell 6036474457 p.4 WBS. HOME IMPROVEMENT CONTRACT / Sold, Furnished and Installed by: Branch Name: JBA ' N' Date: ��Aoe THD At -Home Services, Inc. d/b/a The Home Depot At -Home Services [� 345A Greenwood Street, Worcester, MA 01607 Branch Number: _ 33 Job #: 3 7 7 7 3 B 9 Toll Free (800) 657-5182; Fax: 508-756-2859 Federal ID it 75-2698460 ME Lie # C 02439 RI Cont Lic# 16427 f CT Lio # 565522; M/A Home impnvemmt Contractor Reg. # i 26893 Al Installation Address: �Q6 &gz r 4'� ' [� City State Zip Last 4 Digits of Driver's Porchaser(s): Home Address., . (If different from ( zip E-mail Address (to receive updates and promotions from The Home Depot): Project information: I/Wc(you ("Purchaser"), the owners of the property located at the above installation address oiler to contract with THD At -Home Services, Inc.("H�$m�e j��ot'� to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet 0 V7incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re4uspecdou of the job, Home Depot determines that it cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to comolete the Job was not included in the Spec Sheet or Contract. CONTRACT AMOUNT $ tLESS DEPOSIT S 36 BALANCE DUE ON COMPLETION tMinirnum 25% of Contract Amount due upon execution of this Contract. Indicate Payment Method For BALANCE DUE ON COMPLETION: rp'��.,.wt.�s WRen you provide a check as pmymant. You auehorize us either to use information from your check to make a one-time crectroM- fund transfer 6om your account or to process the payment as a chcA transaction. When we use information from your chock to make an ciccumic Rand ttansfar, funds may be withdrawn from your Account as soon as the payment is received, and you will not receive your cher back. DEPOSIT PAYMENT OPTIONS (Subject to fund vetificauan and/or credit approval.) 1. Chock*, Cashiers Check or US Postal Service Money Order (triads payable to The Home Depot). 2- Credit Card*' and/or other payment options - Cirtle One Below Visa MasterCard Discover American rix ress The Home Depot Home Imp�vern�t Loan Home Dgwt Ctcdit Card 0 New Account [a'1/rds8ng Aeconat (HIL & HDCC ONL1b Available Credit: 5 (ML & ADCC ONLY) Acct#: � 03 T 3 ZO �`o'y}�8 ag Exp. Date: p , Name as it appears on card � \.18r..r itS **By my/our signature below, I(We agree to allow Home Depot to the vereftrenced for the t' sated. 's Signature >�^� HJL, or HDCC Authorization Codes Deposit Final payment # 0052 98 # ops sig Purchaser agrees that, immediately upon completion of the work, Purchaser grill execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. jvntire Agreement: This agreement and its attachments, including any financing agreement, contain the complete agreement beaveen the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely 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 prehl'bits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual eompletier1 of the work to be performed under the contract. You may cancel this transaction any acme prior to miditight of the third business day after the date of this contract See Notice of Cancellation for an expDnstion of this rFrht. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day, but BEFORE materials are ordered. There will be a servim- charge equal to 25% of the contract aramirt if job is cancelled by Purchaser AFTER materials are ordered. BY MYlOUR SIGNATURE BELOW, UWE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORI7E HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BELOW, l/WF AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. SUBMITTED BY: ` Datc: ACCEPTED BY: Dam: Date: Purcbaser NOTICE; ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 9-21.07 rev 4-2-07 CSC white -Branch File Yellow- Customer Pink - Sales Consultant a Po) Mab 06 08 07:34a Rick Odonnel 6038474457 p.4 V,'.4)j HOME IMPROVEMENT CONTRACT Sold, Fumished and Installed by: IV- Breach Name � date ������ THD At -Home Services, Inc. d/b/a The Home Depot At -Home Services 33345A Greenwood Street, Worcester, MA 01607 Branch Number: __ Job #1795313 Toll Free (800) 657-5182; Fax: 508-756-2859 Federal ID # 75-2698460 ME Lir # C 02439 Rl Cont, Lic# 16427 CT Lie # 565522; MA Home improvement Contractor Reg. #126893 Installation Address: J� /ya-', C/e9 " State Last 4 Digits of Driver's u.,mo Phnno! ('Yleiiafer(9): )) WG Pr K Gx . lraW i 1: • •• e ( ) ----- - - _. - ( t5�3—g"8.5'afS' cltd QrCssJGaK I# cds- 'Z3 Home Address: Sime Zip (If different from Installation Address) City E-mail Address (to receive updates and promotions from The Home Depot): Project Information: l/We/You ("Purcliade'), the owners of the property located at the above installation address, offer to contract with THD At -Home Services, Inc. ("Home Dt") to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet # zZ o 6 , incorporated herein by reference and made a part 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 the home, pricing errors or because worts required to comniete the lob was not hidUded its the Spec Sheet or Contram CONTRACT AMOUNT -5 PLESS DEPOSIT S 2� BALANCE DUE !` p ON COMPLETION $ tMinimum 25% of Contract Amonnt due upon execution of diis 6ahtraet. Indicate Payment Method For $ALANCE DUE ON COMPLETION: }}OCC, eSo33 3 apo Qo Y� 5so9 to _VASAX' •when you provide a cheek as paymtut. you authorize us either to use information from your did& tri faalte 2 one-time electronic fund transfer from your acoount or to process the paynxmt as a check awso tion. when we use information Ram your check to make an electronic fund transfer. funds may be withdrawn from your account as soon as the payacent is received, and you will not receive your Cheek. hack. DEPOSIT PAYMEN"j' OPTIONS (Subject to fund ve ifhcation "or credit approval.) 1. Check", Cashiers Check or US Postal Service Money Oder (Made payable to The Home Depot). 2. Credit Card-, and/or other payment 606ag - Circle One Helaw Visa MasterCard Discover American Express The Home 'Depot ]•tome Imlrove mcid lie Iiu Dme�epot Credit Card 17 New Account d Existing Account (HIL & HOCC ONLY) Available eredlh S (HtL & HDCC ONLY) Accu: 473S3;M0�onS'S � ssd� Exp" Date: Name as it appears Y on card: rd a~. &-o~ k k --By my/ora signature below, I/We agree to allow Home Depot to d Je ffifaCtt r tate deposit indicated: s rc HiL or HDCC Authorization Codes Deposit- Final Payment # 0,5-6 qev I# cds- 'Z3 Purchaser agrees that, immediately uptiti c6illpletion of the work, Purchaser will execute a COmpletion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. E reement: This agreement and its: attachments, including any financing agreement, contain the complete agreement between the patties and can not be amended or modified unless in writing in a separate agreement signed by Will paftle5. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you start. Keep It to protect your rights. Do not sight 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 contract. You may cancel this transaction any rime prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an exQlaaation of this right. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day, but BiEFOR9 materials are ordered. There WFM be a service charge equal to 25% of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW, VWE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW My/t)Utt CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCi)RRED FROM IN ADV ERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURF. BELOW, L'WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. IAVE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. SUBMITTED BY: Date:`3'lc��' ACCEPTED BY. gym' r Date. Purchaser NOTICE: ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 9.21-07 rev 4-2-07 CSC White — Branch File Yellow — Customer Pink— Sales Consultant cei5er. 4N. The Commonwealth of Massachusetts. " Department of Industrial Accidents kl�_ Office of Investigations iY �a 600 Washington Street j Boston, MA 02111 Z, ,z www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lesibl_y Name (B Address: .i■ ! iii Phone M Are yo n employer? Check the appropriate box: Type of project (required): 1. Ly�'I am a employer withIf' l 4• ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* .. have hired the sub -contractors listed on the attached sheet. t F] Remodeling 2. F -1I am a sole proprietor or partner - ship and have no employees These sub -contractors have 8. E]Demolition working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its g, ❑ Building addition [No workers' comp. insurance officers have exercised their 10.❑ Electrical repairs or additions required.] 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.❑ R repairs insurance required.] t employees. [No workers' , h Y1J 13. Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. \ n ( 1 ; i - Insurance Company Policy # or Self -ins. Lic. M Expiration Date: Ah 4Job Site Address: City/State/Zip: .✓- Attach a copy of the workers' compensation policy declar on 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 undgF31}e pq{ns i yd penalties ofperjury that the information providedah is tYue and correct 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 ,-__.-.n------ Phone #: 0 Board of Building Regulations and btanaaras HOME IMPROVEMENT CONTRACTOR Repisttatiori:.126893 Ezpiration`_$13/2008 : Type:-.Suppiement Cana THE Home Depot. At -Home S_ervic RICHARD FALtONE'�_'- 3200 COBB GALLERIA_ PKWY #20 At1ANTA, GA 30339 Adndulstrator jdVA"wo -op ep tum sow OM ON as m m S° mm MW 019*0 up GPM eo8W6►UWW 1s" aau WOO q V* kMN3 WWq 6LL909E TTassr3 fiH DLTDb- Z416b8fiZ69 VIZ 3c w6'2LT �oPrgosd opeari S�—>`��+ (3Q fLDZ-H/� St'E.oT3PTA/DD ossa*Sr8 =QPIi SDS : .sw :a=TS P04103 '• �, fL�Z-N/.$ft sseTB/DD wm :URI .ams 'Zr==ate =n6 •Zes�va3 a3a0g . iS =�ZS 'a}saN S x9ti3ei3 (oa)v.9Tba3 (E) rT e --rd roTZTTra PnTt- rT .. •Qzaq;i+a£ 'Te=3�'J ri�AQS ..��ueD uIMOtt 'u=xq}aoM (s)voZbr= �. 8[iS RUM43 so j MUTT E4 Wrtm f -j4jrm M VpMwd Ws7 ep opgda* om W ie �v 0�1'c�H!�adso ie ua, siR>su* a osn un egad �s Oob p P � MM � MW , Sol'dtaiPO+d Wnpuz sp a� to A3aFPr*= smgapum aP �! a>tin u > SW ft t d!Isa elueuWW Melop! p W jMWu aw eRd 9UM aP U P'l le s�1�1d �! ¢0ue0ta>Nad pnp0al raipo ml en4erdlA 4 s1au � aW ayods &M icy P W we iO 4M!ns MSP WWM lau saop PUB lO =u liue puaueuo� lou w M!'sas a P� w°� ! ! W JM los � e J0i pa gw-4MP eR dupMi DliiN s uglpd i � ml sa pmg OHM a! Mdde of uwiu00 M6wp:+ MMatp imp sa>B!ndps Wtiael�W D 0 a!q!MZM ap u0muuuP1 a�ueu�!=�suea a�gisi� rol alwlael�L:: 3�Q M,tFi2tah.3` i MQ NODI NiaW13 �-p� SONLiYd 30N� [ *�0Ht�FF�OLi a41rMWESPMWOMMMOM 1 —� .� Gi' G i yq;r_ e!Eau; aF enueue,:a3ur? Poo n-ioi�ej lUBDUIDD_i U!Prn !Eah RIDS - - =r " opuno0 bunad u�sew� RuOpeh! i t�i1 1, .—... — 7CAT O '� , :I —.IT� r. F (nMrrn,rrvy r T:iI3 O=RTIFICATE 13 1 S S U EF) AS A ` M.:ATT i)F INF0RMAT10=\i /PIRJHFCEI ONLY AND CONFERS `0 RIGHTS RTIFirAT ! i,�Iarsh USA, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND; EXTEND OR ALT"=R THE COVERAGE- A: _+SRU _lD li Y 1 H� POLICIES 8cLO'1!!. r ad t,@Marsn Com - nom- epor-.carreguea�� � Piedmont Rd NE, Suite 1200 --- -- -- ------------------ j �3475 atlant=, G=. 30305 j INSURERS AFFORDINGCQ1%,'Ei4...AGE i MAIC ;0 Fa,c (212) 948-0902—�— ---- --- -- ---1.63 INSURED iIr NSURERA: Steadfast Ins Co 12638877 Depot U.S.A., Inc. INSURER B: Zurich American Ins Co T IHome The Home Depot, Inc. j2435 Paces Ferrer Road !INSURER C.Illinois Natl Ins Co 23817 Building C-8 j IINSURERD:American 30339 —_-- _-- Home Assur Co -_ _19380 c New Ham shires Ins Co FNSURER E. P 23841 iAtlanta, GA COVERAGE5 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT, BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE AFFORDED POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR OD' POUCYNUMBER POLICYEFFECTYE AT M DY POLICY EXP OAT MMON UMI7S T N RD TYPE OFINSURANLIE� IPR 3757 608-02 03/01/08 03/01/09 EACH OCCURRENCE $4.000,000 --_ A GENERALLIABtUTY LIMITS OF POLICY ARE EXCESS AMARENTED1,000,000 €aocrence S PREMISESw X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FXI OCCUR *OF SIR: $1,000,000 PER CC" MED EXP (Any we person) $EXCLUDED PERSONAL dADVINJURY, $ 4,000,000 GENERAL AGGREGATE $4,000,000 PRODUCTS-COMP/OPAGG $4,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PECT LOC HAP 2938863-05 03/01/08 03/01/09 COMBINEDSINGLELIMIT. $1,000,000 H AUTOMOBILE LIABILITY •.• (Ea accident) X ANY AUTO ALL OWNED AUTOS - BODILY INJURY $ (Perperson) SCHEOULEDAUTOS HIREOAUTOS BOOILYINJURY $ (P.,.'dent) ,NON-OWNEDAUTOS SELF INSURED AUTO PROPERTY DAMAGE $ (Per accidere) PHYSICAL DAMAGE AUTO ONLY -EA ACCIDENT $ GARAGE LIABILITY ' 'EAACC':'$ ANY AUTO OTHERTHAN . AUTO ONLY: AGG S IPR 3757 608-02 03/01/08 03/01/09 EACH OCCURRENCE $ 5.000,000 AGGREGATE $5,000,000 A E%CESSIUMBRELLALIABILITY X OCCUR CLAIMS MADE 7 $ S DEDUCTIBLE f RETENTION SWC 1928757 (FL) 03/()1/08.03/01/09 STATU- OTH- rRD XLIMI C WORKERS COMPENSATION AND EMPLOYERT LIABILITY 1928756 (CA) 03/01/08 03/01/09 EL.EACHACCIDENT - $1,000,000 E.L. DISEASE -EA EMPLOYEE 51, 000, 000 ANY CUTtVE EMB R 1928755 (AOS) 03/01/08 03/01/09 E EXCLUDED? OFFICERIMEMBER EXCLUDED? CERIM II ea,desciDeunder E.L. DISEASE -POLICY LIMIT $1,000,000+ SPECIAL PROVISIONS below . OTHER TNS -C45197967 (TX) 03/()1/08 03/()1/09 ccurrence/SIR 25M/2M F TX Employers Excess 1928759 (QSI) 03/01/08 03/01/09 D Workers Compensation E Workers Compensation 1928758 (KY, NO, NY, WI) 03/01/08 03/01/09 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS - *FOR EVIDENCE ONLY CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN THE HOME DEPOT, INC. NOTICE TO THE CERTIHCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR . 2455 PACES FERRY RD., N.W. BUILDING C-8 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ATLANTA, GA 30339 USA ©ACORD CORPORATION 1988 ACORD 25 (2001/08) 8 n 213215