HomeMy WebLinkAboutMiscellaneous - 114 AUTRAN AVENUE 4/30/2018 I t� !�u f�AN �✓e \
uIL®1 GFIL.E
Date'.?-./xe::.nle.....
NO D°:•�"� TOWN OF NORTH ANDOVER
~' PERMIT FOR WIRING
,Sg�1CNUS6�
J This certifies that .... ...............'.:^�! '.:. 'f. r .!
has permission to perform .. f.� ,.. ............................................
wiring in the building of ........................................
at.../.. .�!........... ....... ,North Andover,Mass.
Fee.`/?S............ Lic.No.7G! s... ': ..... .fir
ELECTRICAL INSPECTOR
,- Check #
6 6 ��
Commonwealth of Massachusetts Official Use Only
IBM, Permit Na (D6,10
Department of Fire Services
WIN N Occupancy and Fee Checked .
BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MC),527 MR 12.00
(PLEASE PRINT IN INK ORE ALOWJAve,K-
N) Date: -5-51.::zCity or Town oh9) 0 ,-�r To the Inspector of Wires:
By this application the undersigned gives oti a of his or he . tention to perform the electrical work described below.
Location(Street&N tuber) - AA-
Owner or Tenant Telephone No.
Owner's Address `f -55 '
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Author ation No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of thefollowing table may be waived by the Inspector off, r
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total \Y/
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
AboveIn- o.o Emergency ig ing
No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons g
Heat Pum Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals � '--"" "............ Detection/Merting Devices
No.of Dishwashers Space/Area Heating KW Local Municipaon l ❑ Other
No.of Dryers Heating Appliances Security Systems:*
r Equivalent
No.of Water KW No.of No.of Data Wiring:
ti
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains peva i s of perjury, t the informa on on this application is true and complete.
FIRM NAME: r LIC.NO.:-70(o5
Licensee: Signature LIC.NO.:3oo�L
(If applicable, enter "exempt"in the license number line.) 4 Bus Tel.No. !k—&,7-644q3
Address: S 5 I � n Alt.Tel.No.:
�
*Security System Contractor License required for this work;1 ap t icable,en the license number here: 5S60 0
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's agent.
Owner/Agent a v
Signature Telephone No. PERMIT FEE: $
tea. 4
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Location M/ Al /n4/7 G
No. Date 'v
°RTM TOWN OF NORTH ANDOVER
b 9
a Certificate of Occupancy $
C14U 9
Buildin /Frame Permit Fee $
s�cMusE
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
19887
Building Inspector
TOWN OF NORTH ANDOVER
NORT/1
APPLICATION FOR PLAN EXAMINATION 4-t 6o ;tio
3, �.. 6 0�
j 0
Permit NO: Date Received ��' ! �/
Date Issued: - �9SSvCHuss��y
IMPORTANT: Applicant must complete all items on this page
LOCATION k\i-k Auts-oan Av..
Print
PROPERTY OWNER
Print
MAP NO.: PARCEL: / 5 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:
X Repai replacemen ❑ Assessory Bldg ❑ Commercial
❑ Demolition
❑ Moving(relocation) ❑ Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: � � �, Phone: R15'SS3�8 °13�i
Address: I i-1 A Lx-f r wa V .
CONTRACTOR Name: )Aome -k"N e ouk Phone:
Address: :►-115 34t2ntADO Sk jam,met tom er X1`15-51�-. _
Supervisor's Construction License: Exp. Date:
Home Improvement License: k 1�Stq� Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ . ('�(�(� FEE:$
Check No.: �S� Receipt No.: x
Paee W4
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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:BPPORM05
f
Page 4 of 4
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art ❑ Swimming Pools ❑
❑
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑_ ; '�
Permanent Dumpster on Site ❑ i
Private(septic tank,etc. ❑ Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not/lave access to the guarantyfind
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
F
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS -
FIRE)DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date
COMMENTS
a
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer connection/Signature&Date Driveway Permit
L
i
G
I
Building Setback (ft.)
Front Yard
Side Yard Rear Yard
I
Required Provided Re uired Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
i
Total land area, sq. ft.:
NOTES and DATA— For department use)
I
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4
I
I
Pa��3 of'4
Doc:INSPECTIONAL SE'RVIC'ES DEPAR'FMEN"I':BPFORMOS
Crum ed.MC..I:m.2 W 6
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NORTH q
Town of
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All 3 -
'� dLA ower, Mass., if, Ole
A- COCMICKEWICK
7,9 ADRATED C7
S BOARD OF HEALTH
PERMIT T LD Food/Kitchen
Septic System
�
THIS CERTIFIES THAT......... .....h.... ...C �..s................ Oh6BUILDING INSPECTOR
................ ....:.................................................... Foundation
has permission to erect.............................. ......... buildings on. .. ........ { ^...... ......................... Rough
to be occupied as........ . ... .... ..........
.0{ Chimney.. m ...............................
provided that the person a ce tin this perm shall in eve ryresped conform to the ter
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
31040 IT PERMEXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
UNLESS CONSTRU T T Rough
...... ........ ........................... Service
.. ... ... . .... . .... .......................
BUILDIN TOR
Final
i
Occupancy Permit Required to Ocmpy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. Burner
RE DEPARTMENT
Street No.
SEE REVERSE.SIDEji Smoke Det.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
�
600 Washington Street
- Boston, MA 07111
ivy wwx,.mass.gov/dia
«'orkers' Compensation Insurance Affidavit: Builders/Contractors'Electricians/Plumbers
Applicant Information - _ Please Print Legibly
,Name (Business/ormnizationlndividual):
f
Address: cad`
City/State,Zip: \K: r- Phone ' Oy-1 fs U.-6A'—6 Jl to (,n
Are you an employer' Check the appropriate box: Type of project (required):
1. I am a employer A ith 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or pan-time).` have hired the sub-contractors
1-7 r o- listed on the attached sheet. + 7. ® Remodeling
c.U i 3,Ti a solc props actor' i partner-
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[-No workers' comp. insurance 5. ❑ We are a corporation and its 10-7 Electrical repairs or additions
required.] officers have exercised their
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.[:1 Roof repairs
insurance required.] t employees. [No workers' 13
comp. insurance required.] 1-'.17 Other
';env applicant that checks box#I 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 aflida%it indicating such`i=
=Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.police information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policyt!or Self-ins. Lic. #: L12 k D G 5 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be fonvarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under theepains andpenalties ofperjury that the information provided above is true and correct
Si2mature: .!Cel. �_�.� Date:
Phone �'1'1�S— `l l 2S FJ 1�
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing le one
s g Auth r' �o tt, (circle :)
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: Phone#:
i
MARSH CERTIFICATE OF INSURANCE ATL-000915907-11
CERTIFICATE NUMBER
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
60492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY
INSURED COMPANY
THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY
DBA THE HOME DEPOT AT-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 cert�cate supersedes and replaces any previously issued certificate for the olio
w Y 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 POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MWDD/YY) DATE(MMIDD/YY) LIMITS
A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03101/07
GENERAL AGGREGATE $ 4,000,000
X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000
CLAIMS MADE AI OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000
OWNER'S&CONTRACTOR'S PROT, EACH OCCURRENCE $ 4,000,000
FIRE 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 $ 1,0001000
X ANYAUTO
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON-OIVNED 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) 03/01/06 03101/07 X TORY LIMITS ER
EMPLOYERS'LIABILITY -
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,WI) 03/01/06 03101/07 EL DISEASE-EACH EMPLOYEE $ 1,000,000
OTHER WORKERS
E COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01107
D 16610996(CA) 03/01/06 03/01/07
DESCRIPTION OF OPERATIONS/LOCATIONS/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 MAL 'An DAYS WRITTEN NOTICE TO THE
FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
UABLITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE
ISSUER OF THIS CERTIFICATE.
ARSH USA INC.
BY: Walter Gilstrap
MM1(3/02) VALID AS OF: 02/27/06
RL��a'a,1
AT-HO E Installed
Siding and Windows
vn
/fflr {'fIJ 1I7-7.'.�lr,;iLr/Ir'1 L1J
4f f.7,7.11:�'l7LIJF `
7 Board or Building Regulations and Standards
License or registration valid for individul use only
j l! HOME IMPROVEMENT CONTRACTOR
k
before the expiration date. If found return to:
'I E
Registration 126893 Board of Building Regulations and Standards
Expiration: 8/3/2008 One Ashburton Place Rm 1301
Type: Supplement Card Boston,Ma.02108
THE Home Depot At-Home Servic
SUNROEUN CHHOUY
3200 COBB GALLERIA PKWY#20 .y
Q �x-
AtIANTA,GA 30339 — `° ----- ------g -
Administrator Not valid without signature
Proudly furnished d sold, ur shed and installed b RMA Home Services Inc. a Home Y Y e Depot authorized contractor.
345 Greenwood St.Unit 2•Worcester.MA 01807•S08-756-6686•Fax 50R-756-9Rrq.Tnll Fr—Rnn_ar7-F1 R')
HOME IMPROVEMENT CONTRACT
Sold,Furnished and Installed by;
Branch Name: L)-� Date: THD At-llome Serwoes,Inc:
d/b/a The Home Depot At-Home Services
345A Grccnwoud Street,Worcester,MA 01607
Branch Number. Job#: a 6 S toll Free(800)657.5182; Fax:508-751-2859
Fedrral ID#75-x(198460 ME tele 4 C 02439 RI Cont-Lid!16427
• CCTLic#5566.5522;�MMAQHum frutxoveemmttContmolorlteg.#126893
Installation Address: f✓i M�o Bl---m
City State 7£r p
I.aut 4 D''Lt of Drlve['s Lie_#&rix .MulYr. WoY1r Ptrome' �om1 one:
HLAA &0 I ( ) ( )
Home Address: �? 1!L
(If different from Installation Address) Cit S JJ 1
y �d ��slci�t p
E-mail Address(to receive updates and prornobms from The Ilonic Depot):
Proieet Information: I/We/You("Purchaser'),the owners of the property located at the above installation address,offer
contract with Home Depot U.S.A.,Inc.("Home Depot")to furnish,deliver and arrange for the installation of all materials as
described on the attached Spec Shect# incorporated herein by refi=Lc and made a part hcrcof.
Home Depot reserves the right to cancel this contract if,upon reinspection 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
complete the job was not included in the Spec Sheet or Contract.
DEPOSIT PAYMENT OPTIONS
7 (Subject to fund veriflcation and/urcredit approval)
CONTRACT AMOUNT $ �! (Made payable
i close or us Postal Scoria Money(}ruler
payable mTne Home Depot).
'LESSI)IrPOSIT $ 2. OrditCard*and/ocortszpayment options-CircteOneIkloa
/� visa Mastcreald Discover American E-pm
BALANCE DUE )y dome pgmt Hmne Impmvemcnt The Hamc repCredit edit C-A
ON COMPLETION $ / t
- I t.Xe'wAccopnt IIExlatrngAccount (HIL&NI)CC.ONLY)
Minimum 25%of Contract Amount due upon Available Credit 5-4-k6-0— (HIL&rfDCC ONLY)
execution of this contract
Aar#:�3�3
-- 1Vame as ii appears�,—. 11
y
y.indicate Payment Payment Method For ' •By my/our siter below,I/We agree to allow Home Depot to
BALANCE DUE ON COMPLETION— c c abov urd credit card for the deposit indicated.
Dam —
a*May bre subject to Credit Approval,Fuad HIL or HDCC Authorization Codes
Verification and/or Credit Card Authorization Dc osis Final Payment
id
Purchaser agrees that,immediately upon completion of the work,purchaser will execute a Completion Certificate and pay ally
balance due, purchaser also agrees to be jointly and severally o g ted and Iiable hereunder.
N� Lis r�ca7- 4rc ao -r rno�l�tS
/kntirc't1 reement:This agreement and tt3 aUn
acluents,inchl mg any racing agreement,contain the complete agreement
between the patties and can not be amended or modified unless in writing in a separate agreement signed by bnth 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 saga. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law
probibitm 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 cnntraef.
You may cancel this transaction any time prior to midnight of the third business day after the date ofthis contract. See
Notice of Cancellation for an explanation 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 BEFORE materials are ordered.There will
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, I/WE AGREE TO BE BOUND BY TH.F TERMS OF THIS CONTRACT. UW£
ACKNOWLEDGE RECEIPT OF A COPY OF 1141S CONTRACT AND TWO CO1,VLETL'+D COPIES OF THE NOTICE
OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW,I.tWE UNDERSTAND TIIAT THE AORREMENT IS SUBJECT TO REVIEW OF
My/OUR CRFIDIT HISTORY AND IIWE AUTktORIZE HOML'DEPOT TO VERIFY AND REVIEW MYfOUR CREDIT
R.C.'ORD WITH AN INDEPENDENT DIT REPORTING AGENCY AND RELEASE THL'M FROM ALL LIABILITY
INCURRED FROM INADV ER . 0 SIONS OR ERROKS.
SUBMITTED BY: Date: /.1 171 Q _
nm n
ACC:EPTEDBY: Sal — Dale;���,. UL
Datc:
mmwwtra� .. —
NO'fICE:ADDITIONAI1,TERMS AND CONDrrioNS ARF STATED ON THE REVrRSF SIDE
AND ARE PART OF THIS CONTRACT
10-24-063 C-SC White Branch File Yellow-Customer Pink Sales Consultant
Cd WUOS:BT 90OZ GT 'oaQ 6L96-c9£L@9 : 'ON XUd A-1HWIA WtRld
Location 1/,41
No. Z-3S� Date 4 -A D�
�oRTh TOWN OF NORTH ANDOVER
F • Op
Certificate of Occupancy $
Building/Frame Permit Fee $
s�CHus
Foundation Permit Fee $ '
Other Permit Fee $
TOTAL $
Check #
18981
/—Building Insp�or
NORTH
° p TOWN OF NORTH ANDOVER
o APPLICATION FOR PLAN EXAMINATION
,SS�CHUst�
Permit NO: Date Receive
Date
IMPORTANT: ;applicant must complete all items on this page
LOCATION
Print �
PROPERTY OWNER 2W 'n –t!!tS
_ I� Print
MAP NO.: gS_.D___PARCEL: 15 _ ZONING DISTRICT: I
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT +PROPOSED USE
I Residential Non- Residential
New Building One family
Addition - Two or more family Industrial
Alteratiot No. of units:
)(Repair, lacement Assessory Bldg Commercial
Demolition
ti1oving(relocation) Other Others:
_ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Tyne or Print Clearly)
OWNER: Name: c� ^�y5 Phone:
J ul Sip-nature
'7G' -7
:address: '7
CONTRACTOR Name: �2H (-f — Pone:
Address:
�y(�j1.�,2ti, I LA iy $(�U2p ct'1�� q-576 �c
I
Supervisor's Construction License: _Exp. Date:
Home impro-cmcnt License: l ��(o �R3 Exp. Lute: g ) �p�
kRC'I IITE,CT,FIN GINL'F'R _ Name: Phone:
Address: _ Reg. N _
FEE SCHEDULE:BGLDLVG PERMIT:.510.00 PER 51000.00 OF THE TOTAL ESTMIA TED COST B,ASE'D ON
S 12.5.00 PER S.F.
Total Project Cost :� x l().00 FEE:$
Receipt No.:
Check No.:_
I i
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
❑ Debris Removal Form
❑ Workers 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
❑ Form U
❑ Surveyed Plot Plan
❑ Debris Removal Form
o 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)
New Construction (Single and Two Family)
❑ Building PP Permit Application
❑ Form U
❑ Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
j Workers Comp Affidavit
j 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 it a %ariance or special permit was required the Tow n Clerks office must:;tamp the decision from the Board of
Appeals that the appeal period is over. The applicant must then get this recorded at the Registry or Deeds. one copy and proor
of recording must be submitted with the building application
Ooc:I\.SPEC'noN.U.SER%K ES DEPAR"rNIENT:RPFQR1105
i
J
TYPE OF SEVrARGE DISPOSAL
Tannin'-/Massage Body ,art Swimming Pools
j Public Sewer
I
Well -- I Tobacco Sales -- Food Packaging;Sales
�r
Permanent�
Dum ster on Site
Private(septic tank,etc.
I
i
I
MOTE: Persons contr(tetini; with unregistered contruc•tom do not huve ncces:s to the i;uorantl fund
Signature of Agent/Owner ON Signahtre of Contractor
--
Plans Submitted Plans Waived ❑ Certified Plot Plan i Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE-ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM'
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT (_l
CWater Shed Special Pen-nit
�I Site Plan Special Permit-
Other
ermit-
Other
COMMENTS
' DATE REJECTED DATE APPROVED
CONSERVATION �f
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
i
Zoning Board of,\ppeals: Variance. Petition No:
+
Zoning Decision,receipt submitted yes
P11-nlnim-, Board Decision: Comments
Conservation DCCT ion:- (.onlincilts
Sem CI•connection SIg11atUCC
Temp Dunlpster on site yes_—no Fire Department siggnature.'date
t d
Building Permit approved and Issued by: G(•'
Building Setback (ft.)
Front Yard Side Yard Rear Yard
i Required Provided:—T uircd IProvides Required 1 Provided
i
DIMENSION
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
i
Total land area,sq. ft.:
I
NOT .S and DATA—(For department use) I
i
i
i
i
I
NORTH
0 0 : tAndover
0
No. 11L
o z== LA, o dower, Mass.,
C22 ./0 t
If, COCHICHEWICK
ORATED
`S BOARD OF HEALTH
PER IT T D
Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT..................'..............
' n
has permission to erect..4accepti
.... buildings on /� Rough
y......... .................................................................
to be occupied as Chimney
..... ...... .......... ....... .... .........................
provided that the person his permit shall in every respect conform to the terms of the application on file in Final
this office, and to the provisions 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
Occupancy Permit Required to Omipy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To BeDone FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burnet
Street No.
SEE REVERSE SIDE Smoke Det.
AT-HOME Installed
U si
� Ng I Siding and Windows
71.
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
" Vic...,'`°,
Reg_istrati on. 126893
„Expiration 8!312006
Type Supplement Card
THE Home Depo'.At WOme SeryiC
RUNROEUN CHHQUY f`
3200 COBB GALLERIR PKWY#20
ALTANTA,GA 30339 r Administrator
Proudly sold,furnished and installed by RMA Home Services,Inc.,a Home Depot authorized contractor.
345 Greenwood St.Unit 2•Worcester,MA 01607.508-756-6686•Fax 508-756-2859•Toll Free 800-657-5182
Feb 15 06 12: 31p Michael Bedard 1 - 401 -24.6-2868 pvc
F,O-OE-1006 12:?IPM FR0 14=8 DEPOI4380 W15. 603 894 0414 T'-347 P.004/004 F-448
bold,Fmr,iatled and lwa(lad by: j
DAW T'KD At-He=Set1,(a'm,Inc,
snuKb wove: s &UA The Floma Depot AWouz SerV i ft
Gne"Wbod 9tBett,Wu=W..,MA 01607
3 1
Slt 0:a ����i� Toll Free(h00)fiv-51A FAX:508-15f-.1839el
Bph Mstmbpl .�—� ---�— p dDpli$64&460 6Ai1i 9002434 lUCoxt Li JI L6iZ?
� L7Ti¢ooa6S5771 h7A,�tj=smeIe'garantarc¢Gaxperr,vR¢ti$2689R '
lmlal'(mt(on Adtltersa: C,qy� State 75p
d1Yed�ut'tX�el1 Nli �IA 1ieok 7i,-oen' IABte�t� 3 �---'®' ..a I
1,4
Elnmtr,/addrm: — 5q'•4e��
zip ��`
(lr diPfemnr.from inctplts;iaa
6-.ai Addeete(to rrrdivt updates and ptoatesfeas frorn'rha lgarra
L71ir4�n GVslelYou r"Pa.rchwr^},the ownetn ut the prapetty itteated at the gbave installatlan address oFfet Te ALJ:
port act ottt eine at 1T.S A,�ac.t"Hound Depot'I Ta fturush,daltver:tnd smttga for the instoiladenof a!)mnttr(uts ns
doordbM on the attached ST'`W Sntsi t:_ __ --• incacpormed herein by referenae and rri:.du a pwt hereof.
tIame DeFQe t L'tCYwx the tt�jdt td 6RnGel this mtrm Cr,upon rL-law eaten afthe jolb,Hrmte Depot detemiti s t(tat It
r arts at pLr(&vm it%tth:iRa isax due to a etzUCvAral probYen tehth the hotae,pricing erasrs or bMute work rttglslred to
ooa¢plete the 16b etas not ineNtitnl in the S jwd Sheet or Contract,
DEPOSIT PAYMENT OP'TLONs
--- — (So-b(a1 le.NpC vr,Gulia4 Ludlvf4Mrlf[i�pradu:.) i
r I t^:xel,Cwl�iv�,Clr�etotUSFWW'Servi.Money th4rr !
CONTRAC''T.,%MOTNT iMY:.'ap,wthlet2TL.Home naptgt'
Y1.ES5 EiBP65F T S
1 Ca¢it1AYd• mr.witoptiatx-C1rdaOwTtdw
'dllfi a atr-a
110v'e!r Amcrimn Enp,vee
�ALANCR1DUE :t�Hometmpm mceltwu te¢H¢rxRaperCrrda'sm
ON CQlt3PilETION a_—_ (1 No-a Aear+ast C xlnlga Aowun, A NIL IA III)CL•OMLI)
etlntretuln 25%of t.antruc!Amannt duo wlpan a1&eC9dQn A-U+Ak Crwttt:S — (1111,s HrjCL 0NL'>r
f the ounonoc UP.Da.:—
in lite
arerindicate Payment Metbad Fur
H"(.Ir DUE ON 1r0:6'IPGiv+ll0N •Hy a ylour titnam o tF l¢w, rJre tg ae to wloa tome Depot se thane 1te¢t ve
Fetbronecdam;i'scYr!i'etdta ¢itindiw4sd.
Duo
C At t—waritadi@nCodee—
�----peps@ii Rlpal t'nvmta►1
Putrlrase:tlgrtea d'ol,inamr.siia±sly 4an Iatisracwry completion aftha WOtk,P1tYxbasat'WW eACrsate a Co•rlpiotion CeriAcat
and pay any balance due• i'ttr t,aacr a au even tv bo talati.y nun st o'erailg ebiigated ani Ilabir,hetdun4er.
This:, .n7=1 And Ila or,'asfit Ma.includirs(1 spy fiYi9 daS Im5w,wYdaiz we cc Data uroarnrot
MUM pat sttd can be ammaded a:ieedl[fad tutl:ss;n writing it..L rs�ar a�;etemenl signed by b�t pa i"ee:
ddgngn N011C1£rO @�RCITASES By p
�la ppr¢tKt y e�ri s aUp net fii o �tn vms(r'C�IIIicar�lt"W'd iitik ,e:P b seam soars Law prehlbA same r��I nlr
r(twhe tronteoct CCpt ¢C�nrmt te9om C"ttiftwe stunce try tke earner{pYfrat Btl�hx nctu5l eentPtert2a.of She wtlric is
Vol, itlnn sc 11de.a li@aYba d1f Bhyleoom k a'11mro'aviil e�nto WWIl afiprola Arise cgnMother bot tiii warr t rMaunt ltrtLe!ob h
canteli:d by Ptsetmor AFTER the Wrti bueluese tiny.
HY C'1GtUK S!GNATCIRE BEL0W'iVF A^.rrYE'E Ta DF goUmD E}Y T l•1r TERMS OF THIS C OWAACT, 1AK ACICNIOWLEDGE
RSiCL•IPTWrACOPY 01 TWSCONTILgCr,ti°STWGC0MPI.jTLPSCoplL'SOF'Cti£NCTIC:OFCnYtiCELI�.TiOM,
.v S! RE BRI;3W,UWE t1MD2R3t'.4.N1D THAT THE AGERRASP_"It'(S StlA1BC7 yel ILRV(E'V OFq�WiCA P
a.CNA'rU TOUR CREDIT kEC RD
iSY k1Y101 eW18W ti1Y
r, 7d
^.RC :Y(ItST^R1"ANq t.We AUT,?ORiZ F;OM£cy AND
SJfJEYt hl?iftit'
CREDIT Rt 't7R" [/KNOT S(Ci*?THISCd'0X4ACT REM�ASC THEM ®ZFIC.hRE i►SY RLA KSPACES, �6M
rNAD'�L•Rl'EWTCtsiS NS R 'D
SUBMMEA BY:ED BY:
�ouuc 1 i>r-
� Y
Knmcc
ilrrrwaWna ��a.r
tvtlTiCt:APP:TIn,V'.f.":KMMY,CQ^alrtloNs Ant!U At27,U�.hTt&S Aat:Lt.trno off TSa6 taSVRfi6K hT;;t:Avri AWE retlt aP rl n,co", tt,a2'T
•xbc•-a•et,:b Nl;x Ytt:on-•L\ra.nm i•:n¢-SAW raana�nM
12.5-0$C-SC
I
` Date.
// , ..
NOR, TOWN OF NORTH ANDOVER
Oq 1ti
• O
PERMIT FOR PLUMBING
,SSACNUS� ..
I
This certifies that , . . . . . . . . . .
has permission to perform
. . . . . ... . ... . . .
plumbing in the-buildings of .` t�,!/. °- ' . . . . . . . . . . . . . . . . .
at. . �... . . . . . . .�. . . . . . . . . . . . . . ., North Andover, Mass.
. .
Fed - . .Lic. No.. . . . . . . . . � /d . . . . . . . . . . .
PLUMBING JNSPECTOR
Check # �y� (/
6674
IWIASSACH.USETTS UNIFORM APPLIC
(Print or Type)Ld66) ATION FOR.PERMIT TO DO PLUMBING
AL „ ,/Mass. Date a )
Building Location � 2 =�
Per It #
-ILY11!
(
rn ki
Owner' m
�Type of Occupancy
New❑ Renovation ❑ Replacements
Plans Submitted: Yes 0 No❑
FIXTURES
B.P. # SEWER #
SEPTIC #
z
z
z
z � i 0 a
cQQ�
Ln
O to Q w
w F- U ~ z C7 u�
w to �i O z to w
U U N u_ z z o_
w = m w Q tw ¢ 0 Z p a . Z a I�—
zz z:1 0 U oLu
=
SUB-BSMT LIJ
o 0
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
611-1 FLOOR
7TH FLOOR
8TH FL00
istalling Company Name
ddress
Check one: Certificate
0 Corporation
isiness Telephone 2 ❑ Partnership
s
Ime of Licensed Plumber or Gas Fitter V Firm/Co.
NSURANCE COVERAGE:
have a current If bility insurance policy or Its substantial equivalent, which meets the re
Yes No . ❑
requirements of MGL Ch. 142.
f you have checked es, please indicate the type of coverage by checking the appropriate box. '
liability Insurance policy� Other type of indemnity ❑
and 0
WNER'S INSURNACE WAIVER: I am aware that the licensee does not have the insurance coverage required b C
42 of the Mass.General Laws, and that my signature on thls permit application waives this requirement.
y hapter
gnature of Owner or Owner's Agent Check one:
Owner ❑ Agent ❑
eby certify that all of the details and Informatlon I have submitted (or entered)In above•a
nowledge and that all plumbing work and Installations perfoZeL
ertinent provisions of the Massachusetts State Plumbing Code PPlicatlon are true and accurate to the hest of
r the permit Issued for thl a lication will be in compliance with
f e G era,Law3yTitle of Licensed Plum er
:itylfown
�PPROVED(OFFICEUSEONLY) Type of License:
E].Master 0 Journeyman
License Number �� 3
J. -
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONSSKE�CNES PIIOo11Ess INd►ECTIONs
REE
N0.
APPUCAT/ON FOR P911MIT TO 00 PLUMBING
HAVE i TYPE OF/IIILallo
LOCATION OF BUILDING
PLVIIIM
ri
PERINT GRANTED
DATE .19..._
Kwallia INSPECTOR