HomeMy WebLinkAboutMiscellaneous - 26 VILLAGE GREEN DRIVE 4/30/2018ate IeT�-: o7
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
.ISACHUS
This certifies that
6�
has permission to performl-,-9.1. .............
plumbing in the buildings of ............. ..................
North Andover, Mass.
at A .........
Feer Lie. No.. .
PLUMRN;ZINSPECTOR
Check #
7505
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTSo d'7
Date _
Building Location [ by ` r c S C ��� �� Owners Name ` r f C' l� �' �n Permit #
! �g 8 P c- G Amount
Type of Occupancy
New 0 Renovation Replacement
FIXTURES
::13
Plans Submitted Yes
No
(Print or type)! /� c -,-Check one: Certificate
Installing Company Name [--� 1:1 Corp.
Address v I �c e /7J Partner.'
7-11 1C,r�" CFS
Business Telephone 9 7 r 957, g,(- S- I U Firm/Co.
Name of Licensed Plumber. 4 y /- (-r' --
Insurance Coverage: Indicates the 4°f insurance coverage by checking the appropriate bo)C
Liability insurance policy Ey
+j� Other type of indemnity 11Bond❑
Insurance Waiver: I, the andersiigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and install 'ons p ed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massa ch mbing Code and Chapter 142 of the General Laws.
r
By: i o kens um er
Type of Plumbing License
Title l `9 0 7.6
City/Town License Numm Master Journeyman u
APPROVED (OFFICE USE ONLY
TOWN OF NORTH ANDOVER
Building Department
400 Osgood Street
North Andover MA 01845
Tel: (978) 688-9545 Fax (978) 688-9542
pORTF1
O� .� �E o $ 6 q�0
1- 70
C, eye
O CCICMIC lWICM `
5°R�tev
SgCHUS�
COMPLAINT FOR INVESTIGATION
DATE: ///Wb5— TEL q7� 73� 62�3
FROM: Jxz Cree'%a���Njp
ADDRESS: .c2b
COMPLAINT AGAINST: Ve t- �l
Electrical:
Plumbing:
Gas:
Building Contractor:
RECEIVED
NOV 14 2005
BUILDING DEPT,
Property Owner V`eV-S I If f- C � ��-
Address c<- oz/14D
Other:
M :411,1-1.7
0
W, _
h .1-114C rz
Signed: 2k - — q&D
Revised 11.5.04 C ,/ 4) 0-
61
-
au
Locationc�.�
No. Date�°"� z--'
NORT1TOWN OF NORTH ANDOVER
3?O",t``o "1hot
* ; ; Certificate of Occupancy $
Building/Frame Permit Fee $ i
CHU
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
1564-1
564i1 Building I voctor
Building Commissioner/I for of Buildings Date a 't,CdV
SECTION 1- SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Z5 V1ace.Qw)
' Map Number L Parcel Num er
1.3 Zoning Information: 1.4 Property Dimensions.
Zoning Dislrid Proposed Use Lot Area (s f) Frontage (ft) I
1.6 BUILDING SETBACKS (ft)
Front Yard
Side Yard
Rear Yard
Required Provide
•red
Provided
red . Provided
1.7 water Supply MQLCAO. 54)
Public ❑ Private ❑
1.5. Flood Zone Infomntion:
Zone Outside Flood Zane ❑
1.8 S—crip Disposal System:
Municipal ❑ On Site DisjW System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
. 2.1 Owner of Record
��clncnca. NQ.rnPC-
Z
dI a c), r Dr.
Name (Print)
Address for Service
c)4�6c
AIM6g 1
N. Oda\/e,c Ma. cims
Signature
j Telephone
2.2
e P ' t' 1
Address for Service:
Ba.. cibn
Si ature
Tel hone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor. Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
'44, �� SQfo\� Le, Trvc, r,� DR 0A
Company Name a6 6 g 1
�
3Registration Number �tS G_mmwaokS . ` V .Cte skcr . Ro, Cit 6n
ddre \1's, Expiration Date
Si nature Tele hone
SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application.
in the denial of the issuance of the buildiiXpermit.
Signed affidavit Attached Yes ....... No ....... ❑
SECTION 5 De3crition of Proposed Work check an applicable)
New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s)
Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify
Brief Description of Proposed Work:
LQ:
Failure to provide this affidavit will result
FBI
SECTION 6 - ESTIMATED CONSTRUCTION'COSTS
Item Estimated Cost (Dollar) to
Completed by t applicant
1. Building oa
1 43 L
(a) Building Permit Fee
5
multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Pennit fee (a) x (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 3 5 y 6 Qo
Check Number..
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
d belief
Priam
III Z
Sijalure of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TEE HERS 1 ST2 N IJ3RD
SPAN
DMIENSIONS OF SILLS
DRvIENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Qcj
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HOME IMPROVE ENT INSTALLATION CONTRACT
Branch Name: / " Date: d .:� Sold, F'umish ld R basmillW by
_ The Home Depot Installed Sales
Branch Number: Y Job M: �4 7 345 Greenwood Street, Unit I Worcester, MA 01607
Toll Free (800) 657.5182; (508) 756-6686; Fax: 508-756-2859
Federal IDN 75.26911460 RJ Cont. Lich 16427 CT Lich $65522
MA Home Improvement Contractor Reg. 0126693
.7
Installation Address: �. _t. t r �c.c c. ((' rd,4
ity State Zip c (e J-.
Purchasers): SSM: Driver's License: Work Phone: Home Phone:
t i�:: !• ci!i -_;��L S .� Ir 4!'So (II iil7-24f 68s -r-7
Home Address:
(if different from Installation ,addre.,$) City State Zip
Prpiect In rmation I/We ("Pure, aser"), the .,wners of the property located at the above installation address, offer to
contract with The Home Depot 1 ",Uume Depot") to furnish, deliver and arrange for the installation of all materials as described
on the attached Spec Sheet M i _� ' l,. , incorporated herein by reference and made a part hereof.
Home Depot reserves the right to cancel this contract if, upon re -Inspection of the job, Home Depot determines that it
cannot perform its obligations clue to a structural problem with the home or because work required to complete the job
carat not inpludtd in the rantrart
SALE AMOUNTY S) VQ.,
CONTRACT AMOUNT
*DEPOSIT
BALANCE DUE
ON COMPLETION S`�_j�L__
•25% of Contract Amount due upon etecutlon of
ibis contract (unless project is financed through
Chevy Chose, in which case tw deposit is required).
Indicate Payment Method For
BALANCE DUE ON COMPLETION
s
r
DEPOSIT PAYMENT OPTIONS
(Subject to fund verification srWor credit approval.)
1 Check, Cashiers Check or US Postal Service Money Order
(made payable to The Home Depot).
2. Credit Card* anNor other payment options - Circle One Below
Visa Mastercard Discover American Express
none Improvement Home Depot Credit Card
Available Credit: S ( HIL A;HDCC ONLY)
Acct#: �I I1 0 q J >o� Exp. Date: A --
Name as it appears on card:_G_^
'By mytour signature below, I/We agree to allow The Home Depot to charge the
above reit d t card for the amount indicated above.
INX "L
ar ho rs Signature ate
If this is a finance transaction, the agreement for financing is contained in a separate document, which is incorporated herein by
Reference, and made a part hereof. At -Home Services Credit/Loan Application Ret M
Purchaser agrees that, immediately upon satisfactory completion of the work, Purchaser will execute a Completion Certificate and pay any
balance due (unless the job is financed, in which case, upon submission of the executed Completion Certificate, Home Depot will be paid in
full by the lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder.
For Mas, Residents Only: Contractor, grog+ shall procure all permits required by law as follows: Owners who
secure their own permits will be excluded fro t the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted
within this document, this contract shall not imply that any lien or other security interest has been placed on the residence.
Entire Aaretme_nt : 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 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 yodr rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project
before this project is complete, Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed
by the owner prior (o the actual completion of the work to be performed under the contract.
You may cancer 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 will be a service charge equal to 25% of the contract amount it the job is
cancelled by Purchaser AFTER the third business day.
BY MY/OUR SJONATURL BELOW, I/WE 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.
BY MY/OUR SIC NATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR
CREDIT HiSTOR :'AND I/WE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES, INC., A HOME DEPOT AUTHORIZED
CONTRACTOR, "10 VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING
AGENCY AND RE:_EASE TH FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS,
SUBMI TED BY: jJS1111L, Date: S
J,
ACCEPTED BYF" Date: 0' ✓� d� y
- Homeowner - _ _ • �` // % ��
Date:'
H- meowner
NOTICE: ADDITIONAL TEkMS, LOND(TIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE TART OF THIS CONTRACT
1f {/�C/!IN��1 White - BmnchFile Yellow - Cutwmer Pink - SalesConssul/tant /y 1
ld I
10115101 'i
;d
a qv — M
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office or""Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Afdavit
am a homeowner performing all work myself
Please Print
r
01 am a sole proprietor and have no one working in any capacity
�1 am an employer providing workers' compensation for my employees working on this job.
Gampanv narnF± j�' p rY12 Q-t'v i c lt-S , "Tn t
Address 3 Lao CG�a
b l I`Qr 1-,1,tI Vulcg Z
t-tD 8
Ci#y: ����n�a , Ph^rami, (DM\ Lc, -7 _ Cl tz�
CU
Comm—ay name:
Address
Citv:. Phone #.
WC-aZS-
Failure to secure coverage as .required: under Section 25A or MGL 152 can lead to the tmposition d criminal
and/or one years' imprisonment as well as � penalties in the form of a STOP WORK ORDER and a fine of� � a aline
a ns up to $1.500.00
understand that a copy of this statement may be forwarded to the Office of Ind of the DIA for coverage verification.
against me. t
I do herby certif der the pains and pena*jW of perjury drat the Information Novicbd above is true and correct
'� I1
'ript name
(ficial use only do not write in this area to be completed by city or town official'
DCheck if immediate response is requied Building Dept
)ntect person: Phone A-
4// 7/0
.
RKMA Y'S COMPENSA rlOA!
6//7/0 Z
# -7S4- & It 8
E] Building Dept
p Licensing Board
p Selectman's ice
p Health Department
Other
D. Robert Nieetta,
B ilifin ,> Commissioner
TOWN OF NORTH ANDOVER
Office of the'Building department
COmmmi ty Development and Services
27 Charles Street
North Andover, Massachusetts 01845
DEBRIS DISPOSAL FORM
Telephone (978) 688-9545
FLAX (9-18) 688-9542
In accordance with the provisions of MGL c 40 s 54, and as a condition of
building permit # the debris resulting from the work shall be
disposed of in a properly licensed , solid waste disposal facility as defined by MGL c
11, s 150a.
The debris will be disposed of at / in:
(Site location)
-7)
OZ
Signature of permit applicant bai
Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Dioai, GavPlumbing Inspector
toliRTIFICATE OF LIABILITY INSURANCE
vouCcil THIS CERTIFICATE 4 ISSURD AS A MATTAi
ONLY AND CONPiq& NO RICH" UPON
APPLIED RISK SERVICES, INC. BOLDER. THIS DIRTIFICA'1E 0099 �140T J
P.O. BOX 281800 Sm
SAN F'RANGfSCO CA 94428-4800
ATE«
INSrUR486 AFFORDING C.OV9*AOff i NA10
QUO RMA HOME SCRVICKS OF DELAWARE, INC. ' �-""r--�I p--
3200 COBB QALLNRIA PARKWAY, STE. 200 "ER�,..�..-
ATLAWA, GA 80338
DBA THE HOME DEPOT INSTALLED CALEB.
THE P'aJI.a0156 OF INSURANCE LIETGo min -ow HAVE BEa:N touso TO
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTPRAACr OR
HAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCA
POLICIES. AQOREGATI LIMITS SMOWN MAY HAVE BEEN REDUCED BY
�MERCIAL GGNERAL LMMLITY
CLIm* MADE 1 OCCUR
'L AAGREGATr. UUr APPLas Pffl:
F06W A _ LOC ,- -
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EVIDENCE OF COVES AGF
025-00000503
ABOVE FOR THE POLICY PERIOD INDICATED. NOYWITHSTANDING
IT'H RESPECT TO WNICH Thio CERTIFICATE MAY 86 IMED OR
TCT TO ALL THE TERIA, EXCWMN$ AND CONDITIONS OF SUCH
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3200 COBB GALLERIA PARKWAY, STE, 200 WOTICE TO THE CEIEriWATE HOLDER NAU O TO TMS UP, Wn lA"Ai TO Ov 50 VAL.
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Board otBalldin
= Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Ramon: 126683
EXPWW: 08!0312002
Tree: Supplement Card
s I Home Depot At-Hom Soft"
PAUL VENTRE
3200 COSS GALLERIA PKWY 026
ALTANTA, GA 30339
Administrator
It
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Driver's License _
124846 12.08-01 M 6'00- D $9n4j6"5
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VENTRE
PAUL A
81 W FAGU 8T
E BOSTON. MA
02128
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