HomeMy WebLinkAboutMiscellaneous - 27 PARKER STREET 4/30/20180
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Date ...... I:/ ...... �4? ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ................. ..... 10AC4 - �; � - Y. ........................
has permission to perform .......... .. ec Z.. T. r, 116 : ?.V ............................... I .....
wiring in the building of ........... /< 10. v 4 ..................................... t .......
at ... SJ ... 4kkex- .... 5.7 . . ...................... North Andover, Mass.
ro
Fee ..................... Lic. No. ...........
ET, ECTRICAL INSPECTOR
Check #
2012 Massachusetts Electrical Code Amendment's 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the
Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall -be limited a� to the time of -ongoing construction activity, an4l may be -deemed -by the -Inspector -of -Wires abandoned-and-iuvalid-ifhe--
or she has determined that the authorized work has riot commenced or has riot progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application. . -
The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter238 of
theActs of2012. The purpose of this actistopromotejob growth and long-term economic recovery and the Permit Extension Act firithers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effector existence" during the qualifying period beginning on August 15,2008 and extending'through August 15,2012.
Permit/D.ate Closed:
El Permit Extension Act — Permit/D -ate Closed:
*** Note: Reapply for new permit
I
�N LoU111111WIVIFIVOIL11 U1
Permit No. 7 k1f
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblarik)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PR1NT IN INK OR TYPEALL INFORMATION) Date: '? — I— 1 0
City or Town of. NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives noti , w,(of his or her intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant �i d Ko v Av r- Telephone No. T,7 & (D a
Owner's Address SIPX VW 4
Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box)
Purpose of Building r-�-cwde, � , � \ Utility Authorization No.
Existing Servic��-b Amps Volts Overhead Undgrd No. of Meters
New Service Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
,7�
Location and Nature of Proposed Electrical Work: �< 4 't
Completion ofthefollowing table may be waived by the Inspector of Wires.
No. of Recessed Luminaires -7
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above Ei In-
Swimming Pool grnd. grnd. 1:1
No—.01, Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS7No.
of Zones
No. of Switches &
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
I Number
, .......... ** *
.19p§ ..........
I.NW ..........
I
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El Municipal El Other
Connection
No. of Dryers
Heating Appliances KW
Security Systerns:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring.
No. of Devices or Equivalent
IOTHER:
4ttach additional detail ifdesired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: /000 (When required by municipal policy.)
Work to Start: C', - 3 � - t. o 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 n BONDEJ OTHERE] (Specify:)
I certify, under Ih ains andpenpkes of perjury, that the information on I* ation is true and complete.
this f le LIC. NO.: r
"V4,ySI�4 �ACIL- 17
FIRM NAN
Licensee: T6�,k, I -C e", Signature LIC. NO.:
(If applicable, enter "exempt,, in theficense number line.) Bus. Tel. No.:O",S7& 1-3 (090?
2
187
C
Address: 't vn kki a��n Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-6 1, security work requires Departradn't of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage non -Dally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) El owner El owner's
Owner/Agent
Signature Telephone No. PERMIT FEE. $
a
I
I
lk
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lelzibly
Name (Business/Organization/Individual):
Address:
City/State/Zip:
Phone#:
Are you an employer? Check the appropriate box:
1. El I am a employer with
4. El I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2.0 1 am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. El We are a corporation and its
required.]
officers have exercised their
3. D I am a homeowner doing all work
right of exemption per MGL
myself [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] f
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. F1 New construction
7. E] Remodeling
8. Demolition
9. Building addition
I OT1 Electrical repairs or additions
11. F1 Plumbing repairs or additions
12.El Roof repairs
13F] Other
*Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors 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 insurancefor my employees. Below is the policy andjob site
information.
, Insurance Company
Policy # or Self -ins. Lic. #: 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert�fy under thepains andpenalties ofperjury that the information provided above is true and correct.
Signature: Date:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
PermitALicense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
io
nstallipg Company Name
MASSACHJJSETTS UNIFORM APPLICATION FOR -PERMIT TO
(Print or lype) DO PLUMBING
*47
Date
S119 Permit #
Bui ding �ocati 4 1-77 -Owner
s ame
ype of Occupancy
New 0 Renovation 0 Replacement ge, Plans Submitted:
Yes 0 No 0
FOrm''.
� :czmAfcr) 4�
FIXTURES
%ddre
3usiness Telephone_ 6-A 5_�
4arne of Licensed Plumber or Gas Fitter 11
&2 Check oni�; Certificate
0 Corporation
D: Partnership
;Fmour'AW-t UUVLRAGE:
have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142.
Yes No 0
If You have checked Yes, please indic . ate the type of coverage by checking the appropriate box.
A liability ins . urance policy P____ Other type ofAndemnity 0 Bond 0
OWNER'S INSURNACE WAIVER: I am aware that the -licensee does not have the insurance coverage required by Chapter
142 Of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner 0 Agent 0
iereby certify that all of the details and information I ha. v bmitted JqSentered) in above -application are true and accurate to the best of
y knowledge and that all Plumbing work and installation e su d
s PerfOrme kUn Pr the permit issuAy for this application will be in compliance with
I pertinent provisions of the Niassachusetts State Plumbing Code at4&,tP$t(yl)142 ofithe Gfejferal Laws.
By
Titit
APPR0VCD(0FF10EUSE0NLn
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na'ture of Licensle'd *glurn ber
Type of License: "a -s te r 0journeyman
License Number— q 8
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4arne of Licensed Plumber or Gas Fitter 11
&2 Check oni�; Certificate
0 Corporation
D: Partnership
;Fmour'AW-t UUVLRAGE:
have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142.
Yes No 0
If You have checked Yes, please indic . ate the type of coverage by checking the appropriate box.
A liability ins . urance policy P____ Other type ofAndemnity 0 Bond 0
OWNER'S INSURNACE WAIVER: I am aware that the -licensee does not have the insurance coverage required by Chapter
142 Of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner 0 Agent 0
iereby certify that all of the details and information I ha. v bmitted JqSentered) in above -application are true and accurate to the best of
y knowledge and that all Plumbing work and installation e su d
s PerfOrme kUn Pr the permit issuAy for this application will be in compliance with
I pertinent provisions of the Niassachusetts State Plumbing Code at4&,tP$t(yl)142 ofithe Gfejferal Laws.
By
Titit
APPR0VCD(0FF10EUSE0NLn
L_ I
na'ture of Licensle'd *glurn ber
Type of License: "a -s te r 0journeyman
License Number— q 8
Date..:S..-.2—.7—.—.,.�)9 ...
... ............ .......
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
This certifies that .... 4-Ze�-7-
.................
has permission to perform
........................... !�� . ..................................
wiring in the building of ..... CL ,
Dbt Y ...................................
at ............................................................................... . . North Andover, Mass.
Fee.'� ............
.................... Lic. No. ........ ...... �0...
ELECTRICAL INSPECTOR
Check #A d-,), q
6531
AN,
Commonwealth of,Massachusetts 011icial Use (Only
permit No.
Department of Fire. Services
Occupancyand 1-ce Checked
BOARD OF FIRE PREVENTION REGULATIONS jRcv. I 1/9,)j
.1ve
APPLICATION FOR -PERMIT TO� PERFORM ELECTRICAL WORK
All work tco 6L perfi)nnetl in accoftlance.with the Mnsachuselts 1:1"riL*!" "' '
(PLE;4SEPRINT IN IjVK OR T)"PE,4LL INFORA14710N) Date_L_4
City or Tomm of: To 117c, 11
By this appi ication the Undersigned
Location (Street & Nu ,,;,y'csplcep usorlier'nten - tion to perforni the electrical work- described below.
mbe :Ark, 6 Z_
Owtier or'I'enant _bo"N) A Cj01V0--\1- Telephone No. LIK:)(036�f
Owner's Address f I
Is this pennit in conjunction with a building
permit? Yes No
Purpose or Building Utility
Existing Service Amps Volts Overhead n
New Service Amps Volts OverheadEl
Number of Feedersand Ampacity
Location and Nature of Proposed Electrical Work: P4�� I r+'. AL
4 (Check Appropriate Box.)
.11thori7ation No.
LlndgrdEJ No. (of Meters
Undffrd
b El No. of Mders
"I... /Jt .......... ... 11 1
No. of Recessed Fixtures
No. of Ceil6-Susp. (Paddle) Fans
.. ... .... .....
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. (of Lighting Fixtures
Swimming Pool Above Ei In- n -"'No.
gi-nd. grnd.
ol Emergency ughting
Batte Unit
u " "'
No. (or Receptacle ou(iets
No. (if Oil Burners,
FIRE �Al�,ARMS;
No. of Zones
No. orswitches
No. orGa% Burners
go—of Detection and
Initiati"L, DevicL-S
No. of Ranges
el
Totai
No. of Air Cond. Tons
—
No. of Alerting Devices
No. (if Waste Dispose"
Heat
Totals:
Number
Tons
KW
No.- of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El Mu icipal
"1 0 ot
I Connecilion her
No. (of Dr yers
Heating Appliances KW
.
security Systems:
No. or . Devices or Equivalent
No. of Water
Heaters KW
N o. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or E(luivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
I
TelLIcommunicatio s Wiring:
11
No. or Devices or rAuivalen t
OTHER:
........... .
INSURANCE COVERAGE: Unless waived by (lie owner, no permit for the performance of electrical work- may ISNUC on JCSS
lhe licensee provides proof of liability insurance including "completed operation" coverage or its substani ial equiv;1leill. 71he
Loidersi-ned certifies that sucl overage is in force, and hascxhibited proofol'saine tothe permit issuing, ollice.
L, llvv�'
CHELX ONE: INSURANCE)�SL BOND El OTHER El (Speciry:)
Esliniated V111LIC of Electrical Work: (When required by 1111.111iCipal policy.) (Expiration Daie)
Work to Slart:.A:SAJP — hispechons to be requested in accordance with MEC Rule 10,and upon compleii0n.
I vertif',, under the pains and perialties qf'perjury that th injimnuttion t
)" thiv q)I)fication & true and canildele.
FIRM N LIC. NO.:
l'iceusee:—jb'6V-_) C:'V�an -L' Sign it tur(5�__.r_*3z
el LIC, NO.:�& Lrr? A
Bus. Tel. No.: III I
Address: �0 Aft. Tel. No.: q')g L03 110's
OW ' NER'S INSURANCE, WAIVER: lani aware that (lie LicensecAws no/ have the liability 111SUranCe Coverage normally
required by law. By my signature below, I hereby waive. tills requirement. I -,in) (lie (check one) 0 owner- 1:1 owner's apLml.
Owner/Ageni
Telephone No. EE: S
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WILLLAM J. SCOTr
Director
0
r
Town of North Andover I v4ORTN
0
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES 60A.- I
146 Main Street
o
North Andover, Massachusetts 0 1845
in accordance with the provisions of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be disposed of in a
properly licensed solid waste disposal facility as defined by MGL c I 11, S 150A.
The debris will be disposed of In'.
—D, � C 420's VA I
(Location of Facility)
Signature of Permit Applicant
Date
NOTE Demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
If
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
104
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number Date
THE BUILDING LOCATED ON
MAY BE OCCUPIED AS
THIS CERTIFIES THAT
c- e�;-- IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY "PLY.
CERTIFICATE ISSUED TO —C-14EaC—
ADDRESS
Birilding I�pec�
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Location 4 �I aA,--4e-
No. &_9 151? Date
TOWN OF NORTH ANDOVER
\0
Certificate of Occupancy $
Building/Frame Permit Fee $
CHU
Foundation Permit Fee $
Other Permit Fee
TOTAL
s
Check # 11FIf
17191
C//'�—Building I
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUNMER: DATE ISSUED:
SIGNATURE:
Building Commissioner/Inyector of Buildings Date
SECTION 1- SITE INFORMATION,
1. 1 Property Address:
1.2 Assessors Map and Parcel Number:
o33 605� 7
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning Diar ict Proposed Use
Lot Area (sf) Frontage (ft)
1.6 BU11MING SETBACKS (ft)
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Re i
gwred Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone 0
Municipal 0 On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHM/AUTHORIZED AGENT
2.1 Owner of Record
)),qv1^i0 kovtAcrt- ;L7 5�7-�
Name (Print) Address for Service
Signature Telephone
2. Al
Kr4u,�)Cvmr
mwzj
Name PrinPl Address for Service:
efimiodure Telephone
:�ECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable 0
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home lzrovement Contractor
Not Applicable 0
Comp6y Name
Registration Number
Address
Expiration Date
Sigmmv Telephone
M
M
X
z
0
90
0
on
ic
SECTION 4 - WORKERS COMPENSATION (KG.L C 152 § 25c(6) I
Workers Compensation Insurance affidavit must be completed and submitted ivith this application. Failure to provide this affidavit will result
in the denial of the issuance of the building,0,'it.
Signed affidavit Attached Yes ....... R` No ....... 0
SECTION 5 Description o Proposed Work (check applicable)
New Construction 0 Existing Building E�" Repair(s) 11"P erations(s) OXAddition 0
1 , ;:i
Accessory Bldg. 0 Demolition 0 Other 0 Specify
N I'&
Brief Description of Proposed Work:
I UTTION 6 - RIMMATRD rnN'QTR1TCTTnN Cn4ZTQ I
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIALUS9 ONLY
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
-3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
-5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
btUllUIN /a UWIN-EK AU IHURIZA'110,N TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 1 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/,,(UTHORIZED AgEtq DECLARATION
as Owner/Authorized Agent of subject
propertv
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Signaturr r ient Date
NOMF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS I ST 2 ND 3 PD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
S17 -E OF FOOTING X
MATERIAL OF CHRvINEY
IS BUTLDING ON SOLD) OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
I
granch Name:
Date: Instalicd by
.04 Sold. Furvished &
Ple I foulc Dqm( ln,,tallcd Sales
Branch Number: .[till ih vnwood Streei, Work�vmvr. NIA 0 1 (,4)7
34.iA (;w
1.1ce (900) 0q1-4iI82. 1508)
Nil: Lic: ('024;9 141 Lml. Lie!; 14,42 Cl'Liom 5wc,_2
i I i v I tn;)i , wc it .mt 1 '4 vio a, Im I k :-'I, i
livitallatiun Address:
.75
CaN.
Zip
, - I se, (S S4 P. DiJIV! Wmk Illitme: Itonve Illieniv;
run 'I
Slate 7ip
Proleci Infurnialio Ve ("Pluchu":C). tile ownd,; ofthe propomy ltwalcd ut the ;IN,ve insliAlhiliol) addiv's. ofl�r to coluract \k illi
Till.: I Ionic Dk�pw (I lonle Depol") (o filnti.,li. defil. erand an-ange I'M tile illItAliLlitIll til'Ill I illatemils as dcwrjt)cd (']I III,: Madiled S17"
S!1,7,:t 1: mcotporaled lll:fCill hV V01MIll< LUld ol�J& U IMrt 11CIC(It'.
Iloille Depot reserves tile I-ight to Cancel this Cordravi if, ollon re-ill'spectioll of %he jull, Home Dirpol delleramines (hill it cannot
its obligitions due to I Sirtlefurall prolsleryl Ivith file horne fir because %ork require(] rib ciiallplete tile jol) ivp, ,III
included In the contract.
CONTRA( 'T AN1101. NT
1I.E.S.1i
IIAII. AN( E M IF -
U -N . COM PLE'l-lo's S
1!il, of CtIntlAvi Allititint due ullion vNecolitip off lhi%
Can(rilec- (hie-1hird (1.1") off 'onfr�ci .\nmaint i, m-timil-ed
for tit 1ISSM.lit SE I -I", 14p4 t)J.N,I,S 4IN1.1,
Indicalt: I'mment Niethoid For
BALAN
DEPOSIT PAN MUNT 01"FIONS
Mali" 1"): 1, 1'. J 11, 11..-' 111.4,
""fil I'm& �,l ;xh- rm� "J,,- - I'
V i.,-, hb'j�-41'Arj J)i r Anmic; J
r.." cn) "an <]], ,, �wL Pql �Crm
4'aitahl" Cre,fil: S I I I I I & I I IH'(' ON
I.L:e
A
I I'l, !S it I-1110PIX 11;1111,'�IC(iD[l, (11C Lk_1J*eCJlk1I]t lt)rfinkallcitill I, elm(aillcd ill it sopurale dockillicill. wilicil is in.corporalell lvrcill h�
RVI&C11cc, jnd Inattv it Ititil li,:rvol'. M-111(inte Services Credit/i,mill A I)plicat jott Ref.
litirelillsel LLeIrc, Ill;lI, upmn uisfiacliry c%)1opIel30tJ 1�1* (Ill: IV(". 11(1r�jlitser will CNe"'I" �' ('11111111C110n CMI&C.11C ![fill lltly JLIY ]VII.11101'
dtic tim!"SS'dic jot, i, lilunwed. ii -i uhich case� tip.;n -.,tibmjsSK1L1 Id 11W VNXCLAW Compliniori (.*cnille�Itc, lil�llle DU1101 Will bC 11iLid Ill 11.111 11, Ill, -
It' b< i0i"Ity ilt'll --'1TI`JIIY ohligalc,l ;,,)it lial,le herk,.unifirr.
J�M Mass. Resi(Jenis OIIIV; (. j)o1ractol SJ1401 procurc all pvrmii,,s required by law niing its IN: owvr's' Ue'll. 0""WIN 101�1 -secor-c ilicir
Imn permits %%it] I)t! vxcJLl(lt!jJ fr011) OW LL13ranty lund provisions ol' 'MG1. k,ll:IptCr W. -N. LW,:%�' 011101kiSC 111)(CLI S%illlill flll.�
doconielit. thi�- conlract .11WH film imply diat any licit or other ieimrity inler—i has Nxii plac%�d oil ifiv. rcsideitvo.
Enrim Agreemem iii, ;tSrvcoIL:l1 atilt il_4� iffiltC11111CIIIN, :11cluclilIg 811Y lilliulL:ilIg cOnWill IIIC Clillit'lete agneemoni
1101% CCII 11IL2 INIrfiCS Wid &;�Jll liol. be MICildcd 01- Ill(HlifiCd ULIJCSS Ill WI-ililig Ili a itqiaraiv agnmilm siyiivkl by hml) pjnics.
NOTICETO PURCHASER
00 luit this cOntruct liefore You read it, Von are "Willed tit a completel - v filled4n colty of tile conir;lcl at tile little yon %ign. Weep it Ili
po (Acet y4mr rights. Dip tint sign any ( oinple,tiosm Certillwaie or agrluentmi slalior (flat pm ire Sall."firti 'nitil [lie viltire priijmt beflore (Ili%
llrajeei I, conipleir, LaNi prnhihivi hinne repair contracturs from jimlae,lfiK, I,- actj)'fing a Comptili(m ('etliticale,
prior To the actnat complefinn of tile mil -k Io he perf,)rIne(I uncle, file curnt-livt. ignett fly file I,%% It,
11"Ill "'a, vilfict-I lfii� trarmiaim, sit ;Ill - v Iiniv priviv it) midnight If The third litisinem, dat. after the sla(e 'if this comiracl. 1we Nolive of
Cancellativil for an vxplanalian ar this 1-4,11it. Illerle vvill be a servive charet C(IMIJ (It 25% 01' IhL %kinfraci U1110RDI if lite joh is cancelled ill
Parchaser AFTE14 lite lhirll lintin,.s.m jig%.
4AW4ATI:lRl: 131:1 OW: FAVT M;RIT. 13J: ' lj()t.l1N 1) [IN' 'fill: T.UHNrK OF TQIS CONIRACI. I.AVI: ' ACKN0WI.lJ)(,k
HPI'(W.-A 01PY ()I I Ili's CON IRACT ANI) l*%,'ji(,('A4VI 1-11:1) ( ( 4111-1, 01 1:1 1 AIJON
(IN' kl%'()IIR V1401161AND THAf 'IFIF A(iRJ:I:',(J!N'l IS [41 [)1,
HISIOR) ANI) IAVJ�AITIK)ItIZI�1110\ff I ) U( W"I RACI (1k,
- ill NI*NT CRLM I' REPOR I J\C A61- NCY AN[) R 1:1 1 ASt.
Vl'klf:Y A1,D l(JxJl:ilV KJN*;Oj!R ( l(FI)i I' RE( ORD W1 I I I AN INDI
DFPM AND IkKIA I ION -11: SLAM( AC., A I 10MI: DI -14 It' AU l'lIIMIZJ'
I HEM I KOKI At I I IAHtI I I It, JNCI:kRl;D l'R()KI tNAIIVl`l?'l EN t"WIN'SION'S OK I.RROIJN.
S1 Illm ITTFD,!� Date: .3
AC( T11 1'1:1) 1
Date:
NOFN F� M)MI I(YN.Aj. i Till,'
� )-kli ( N(
I
3
MFB#863
Ovens Corninq
NMC 6100 Renovations
Double Hunq - Vinyl
i0i Lov E (HC) -Argon
RdV
NONE=
dWq1Lkrwdff1d*
JL-
Ufaft 0.37 S&Hwmu .51 VM 0. 52
CF. -3767 C~ 1111111101110 07.-S-5
emmmad PMWd=
C,
iftodwct mots Ruergy star
1guidelixwe; for region(a):
Contra]
bpr4' 5 *11.0 :EdXD: MN AUGLASS SS/*11--R45
Test Size: 36 x 60
Order #:2958082030002 40177
pa7
02.1
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration' 126893
Eipfration: 8/3/26(9
Type: Supplement Card
Home Depot At -Home Services
MARK AUDETTE,
W3200 COBB GALLERIA PKWY #26
ALTANTA, GA 30j39
Administrator
. . . . . . . ......
CERTIFICATE NUMBER
AIL-000910307-Oi
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATICIN ONLY AND CONFERS
MARSH USA INC. NO RIONIS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
ATTN- BRENDA BOOKER POLICY. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE
3475 PIEDMONT ROAD, N.E. AFFORDED BY THE POLICIES DESCRIBED HEREIN.
(404 995-2S94 OFFICE COMPANIES AFFORDING COVERAGE
(404L760-5768 FAX
ATL TA30305 COMP MY
iOO492-MASTR.RMA. RMA A STEADFAST INSURANCE COMPANY
INSURED
COMPANY
THD AT-HOME SERVICES INC.
9 N/A
DBA THE HOME DEP07 AY -HOME SERVICES
COMPANY
2455 PACES FERRY ROAD NW
BUILDING C-8
C AMERICAN HOME ASSURANCE COMPANY
ATLANTA, GA 3M39
COMPANY
0
5ifi""O " 9w_
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESMIRED HER13N HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED
NCIYVATHSTANDING ANYRECUIRFMFNT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTYATH RCvFCTT0yVHIOH THE CERTIFICATE MAY BE ISSUEDOR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE PotiaESDE"IBED HEREIN ISSUEUECT TO ALL THE TERMS CONDITIONS AND EXCLUSIONS OF SUCH POLICIES AGGREGATE
LIMITS&40M MAYHAVE EIM REDUCEDBYPAO CLAIMS
GO
TYPE OF INSURANCE
POUCY MUNKR POLICYEFFECTIVE
POLICY EXPIRATION
LIMITS
LIR
DATE (MNIDOfYY)
DATE (NMIDDfYY)
GENERAL
LIABILITY
GENERAL AGGREGATE $ 4,000,000
PRODUCTS - COMPOOP AGG S 4,000.000
A
X
COMMERCIAL GENERAL LIABILITY
IFIR 3757 605-00 02101104
02101105
CLAIMS MADE FX] OCCUR
I-IMITS OF POLICY ARE EXCESS'
PERSON& A ADVINJURY $ 4.OW,000
OAWER'S A OCNTRACrORS PRCIT
IDF SIR. S11,000,000 PER OCC'
EACH OCCURRENCE 3 4,000.000
FIRE DAMAGE (Any one Its) S 4,000.000
MEDEXP(Arvyonsperom $ EXCLUDED
AU70HOBLE
LIABILITY
CCMBINED SNCLE LIMIT $
ANY AUTO
BODILYINJJRY $
A.L OfMED ALJTOS
(Per per—)
SCHEDULED AUTOS
80DILYINXRY
$
HIRED AUTOS
(Per owderA)
NCN-OW4ED AUTOS
PROPERTYDAMAGF - S
GARAGE LUUHLFTY
AUTO ONLY - EA ACCIDENT $
MY AUTO
OTHER THAN AUTO ONLY -
EACH ACCIDENT $
AGGREGATE $
El CE 3 S LIABILITY
EACH OCCURRENCE
AGGREGATE S
FUMERELLAFCRM
10THER
$
THAN UMBRELLA FORM
D
WORKERS COMPENSATION AND
SLIATU
X 1 rOCRY M Tj E_R
EMPLOYERS'LLAII&ITY
EL EACH ACCIDENT S 1,000,000
EL DISEASEPCLICY LIMIT 5 1.000,OOD
C
THE PROPRIETORI INICL
RMWC2981992 ADS 02101104
OVO 1105
D
PARTNER9EMOLITIVE
S 1,000.00()
OFFICERS ARE* EXCL
EL DISEASE-EX>4 EMPLOYEE1
C
0714ER
WORKERS COMPENSATION
DESCRIPTION OF OP ERATIONSILOCATION SPA NIUE SISPIECM ITEMS
RE: LOCATION NO. RMA.
;A �00_00"Cn?
9404" ANY OF THE PCLIOFS OFS01810 HEREIN If CANCELLED BEFORF THE FXPIRAInON DATE TWRFOF.
THE INSURER AFFORDING COVERAGE IMLL ENDER400t TO MAIL 10 DAYS WRITTEN NOTICE TO TIC
CERTIFICATE HOLDER MAMID bEREIK OLOT FAILURE TO KWL SLICH NOTICE SWILL IMPOSE NO OBLIGATION Ot
LIABILITY OF ANY RIND WONTHE IMSPtR AFFOROWO C016RAGE. ITS A�GFNTZ OR REPRISEWATIWS 04 Tw
I
iSSIJFR OF THXCFRTIFICATF
M 0
ARM U&AIMC.
F
Y: Frank Kinnett N
VAUD AS OF -02/02/04