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Miscellaneous - 349 MARBLERIDGE ROAD 4/30/2018
N O � O g W O � v c� Q m O og MetLife Auto & Home® Homeowner Operations Field Claim Office Attention: Claims P.O. Box 6040 Scranton, PA 18505 (800)854-6011 August 18, 2016 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: Claim Number: Date of Loss: Charles Iglesias JDG22346 4C August 16, 2016 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 3B, please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 349 Marbleridge Rd, North Andover, MA Sincerely, Anthony Grasso - FLD Metropolitan Property and Casualty Insurance Company Claim Adjuster (800) 854-6011 Ext. 7480 Fax: (866) 404-8179 Email: agrasso@metlife.com MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates, Warwick, RI. MPL MA-REGDEPT Printed in U.S.A 0698 Date .stie..[!4 ......................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...... ... ..... ........ . .. ... .. . ..... .... .... .. has permission for gas installation )f in the buildings of 5!\n .................................... ................................ 3�1,,tO� J9 jf� ... J - at ......................................... .4 . ................. . North Andover, Mass. Fee,b,') ...... Lic. No. ... .HO'' .................................................. GASINSPECTOR Check # 9 kPI 15 9`452 SIN MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 CITY N. Andover MA DATE 7/31/2014 PERMIT # �2-(f JOBSITE ADDRESSI 349 Marble Ridge Rd OWNER'S NAME �?t GOWNER ADDRESS I Same TEL[ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL[j PRINT CLEARLY NEW: ❑ RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YESE] NO E) APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS ! MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER ----------------------- Re lace 1 Gas Meter(s) x and Associated Piping I t INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY (❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT Ll SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c liance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME I Joseph Marino LICENSE # 8736 U SIGNATURE MP [Z] MGF ❑ JP ® JGF [I LPGI ❑ CORPORATION E]# 3285C PARTNERSHIP®# LLC ®#�� COMPANY NAME:j RH White Construction Co ADDRESS 41 Central St CITY Auburn STATE MA ZIP 01501 TEL 508 832-3295 FAX 508-926-4347 CELL 508 832-4614 EMAIL JMarino@RHWhite.com ROUGH GAS INSPECTION NOTES I THIS PAGE FOR INSPECTOR USE ONLY I FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES U -s-, TIT . •0 Pl.r Co uj LLM CO Z. in ZT, mOV71 -, LL Uov. -ra -.U)l IN A-4 LU wmoo "La. wd 0 ,.0 "y 16 1-T ZE V4 u MJV LL d -0 m w ul Lu LU -Ao �CC7---MON �® �. CERTIFICATE OF LIABILITY INSURANCE Page 1 of z 08/29/2013' T,HfS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE; AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the poliWies)must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does notconferrights to the certificate holder in lieu of such endorsement(s). 9rillia of Msesdebugotta, Inc. c/o 29 uOttusyy Blvd, P. 0. Box 305191 Nngbville, TN 37230-5191 R. X. White COrlatruotion Company, Inc. 41 CmntraJ, Street P. 0. Box 257 Auburn, MA 01501 INSURERA: The Chart 'r Oak Piro Insurance INSURERS: TravQlArt, Property Casualty CC, INSURER C_NatiO4AI Union Piro Ineuranca INSURERD; Travelers Inda=jty Comoanv so-sp/-E3"!Ij NAIL 1 a742 oP Am 25674-001 p o£ 7.944S-001 25659-DOl VYCKPICitzi CERTIFICATE NUMBER, 20287680 ' REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 6 TYPE QP IN ii GENERAL LIABILITY IMURC1AL GENERAL LIABII.ITY CLAIMS -MADE OCCUR LIMITAPPUES PER: VTC20co 977209948-13 9/7./2013 1'9/1/2014 B AUTOMOBILELTABILITY VT.7CAP 977R955A-7.3 9/1/2013 9/1/2014 X ANYAUTO A08NED SCHEDULED X HIREDA NON-OWNED AUTOS X Co Defl X Co11 Ded C LIMBRELLALIAB X OCCUR 836766140 .9/1/2013 9/1/2074 FXC9 :0 UAB CLAIMS-MAMP LIMITS EACFI OCa,h v 2, 0 0 0, 0 0( S o0r MEDEXPon)$ 10"QOa PERSONAL&ADV INJURY GENERAL AGGREGATE S S 2 000, 000 4,000,000 PRODUCTS-CoMPIOPAGG $ ,.000.000 4Mt3— 1rEDentSINGLELIMIT ac d $ 2, 000, 000 BODILY INJURY(Perperaon) Is BODILY INJURY(Peraccidont) $ DED }; RETENTION$ 10,00C D WORKERS COMPENSATION '�►TRRUEi 62057,Ta5-13 [9/3-12013 9/1 207.4AND EMPLOYER9'LIABILITY YN /D ANYPROPRIETORIPARTNFRIEXECUTIVE VTC2XTIB 820A71A-13 9/1/2014T OFFICERIMEMB�REXCLUDED?NfA below Evidence of Inmurance F_.L. DISEASE- POLICY LIMIT Remarks 3chedula, Ir more ep see 1,000,000 1,000,000 1,000,000 SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE CoXI44297604 xp141694012 Cent;:2026768o ©1988-2010ACORD CORPORATION. All rights reserved, CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD NORTH OG O 9 ,SSACMUS� Date. . TOWN OF NORTH AN PERMIT FOR PLUM G cR This certifies that ..... ACA75...../ !... �.............. has permission to perform .....6� .... ............. plumbing in the buildings of .../'4 l l ................... at ...... �?�f ... /t?�'`'t'J�Z,!>�.4!c."e....... North And ver, ass. Fefs,49 ° ... Lie. No..y 71 / .i A.�� /........ . PLUMBING INSPECTOR Check # i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building f New 0 Renovation 13 (Print or type) Installing Company Name Address of Replacement ' FIXTURES Date ol Permit # Amount Plans Submitted Yes ❑ No Check one: Certificate n Corp. EDPartner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate thety a of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this applicatio three insurance n does not have any one of the above ignature Owner13Agent ❑ 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 installations perf�o ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State gmbmQ"�-` �-. D� �M. - apter 14 of the General Laws. I Title (APPROVED (oma usE oNLy Type of Plumbing License 1'�71 � - tense um er Master [ Journeyman ❑ Date .../Xx.... .. . TOWN OF NO �T,H ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....11f-- Lf. `, .... J�l !' . • .. • • . has permission for gas installation ... ...... in the buildings of ... at ..3e. ....... North Andover, Mass,. Fef ?U ��U.. Lic. No../5x/7/. ... !�..+ ....�� GAS INSPECTOR Check # 0� S 6949 I MASSACHUSETTS UNiFoRM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date , ' 2 -ICK) NORTH ANDOVER, MASSACHUSETTS 7 Building Logations .) �i �l 1 "I�J iya- .S1IN-S Owner's Name New1:1Renovation 1:1 Renovation SU B-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH..FL00R 8TH. FLOOR (Print or type) 12t3 `�i�� Name Permit # Amount $ Plans Submitted ❑ U x w ° rs � w e mz e x a a W Z: Name of Licensed Plumber'or Gas Fitter fL A� X.11. r: .. . Check one: Certificate Installing Company ❑ Corp. ❑ Partner. ❑ -/.WCo. INSURANCE COVERAGE I have a current liability Insurance, policy or it's substantial equivalent. Cheooe: If you have checked yes, please indicate the type coverage by checking the appropriate box. No❑ Liability insurance policy Other type of indemnity ❑ Bond13 Owner's Insurance 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 ❑ Agent ❑ hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed un it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas.C,,gd d P�nerai-Law, By: Title City/Town, APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber n 0� Gas Fitte E3r Plumber / V71 [:3 Gates Fitter�cr� a um er ©�IGiaster ❑ Journeyman � C :Lo cation ` No. a Date NORT►, TOWN OF NORTH ANDOVER ' n Certificate of Occupancy $ LS < 0 6 • i ; , Building/Frame Permit Fee $ Z I , 61 �•�s',^�'''<� s�cHust Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector 7113 s'•" Div. Public Works PFmctrr ho. d APPLICATION EOR PERMIT TO BUILD — NORTH -ANDOVER, MASS. PAGE 1 I /) /_ 1 /� I MAP 4.40. I LOT NO. 2 RECORD OF OWNERSHIP .'DATE BOOK .'PAGE ZONE SUB DIV. LOT NO. — LOCATION /! PURPOSE OF BUILDING I OWNER'S NAME A OWNER'S ADDRESS3i19 ffi19 //,elf r17/J.ii)� f c� NO. OF STORIES SIZE BASEMENT OR SLAB 1 CYST ARCHITECT'S NAME/► )��/1e51�L. SIZE OF FLOOR TIMBERS z-;( 2ND 3RD BUILDER'S NAME In r/ £�� eD -,S _ Ti J � SPA Gs DISTANCE TO NEAREST BUILDINGC)U� �� DIMENSIONS OF SILLS DISTANCE FROM STREET �7 ZC/ POSTS DISTANCE FROM LOT LINES SIDES Zs REAR GIRDERS AREA OF LOT FRONTAGE[-`'�� HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION j(� - _ MATERIAL OF CHIMNEY. IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ,WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 1. f.s Jl IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 t PAGE 2 FILL OUT SECTIONS i - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING A ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS V/PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR D ATE FI TURE OF OWNER OR //ITHORIZED AGENT 4p 41 F E E /4�" PERMIT GRANTED 19 ��aay6 OWNER TEL. #-61-2- CONTR. TEL. # CONTR. LIC. #.Prep 4-- 3 3 PROPERTY INFORMATION LAND COST -EST. BLDG. COST EST. BLDG. COST PER . FT. V EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN Irnm ww"wmv Inir6.-Fun I OCCUPANCY= r SINGLE FAMILY` TILE FLOOR TILE DADO 'STORIES - V MULTI. FAMILY 1 1 ; HEATING OFFICES APARTMENTS " _ CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR 'FINISH CONCRETE PINE 3 1 2 13 CONCRETE BL'K. BRICK OR STONE _ HARDW D _ RADIANT H'T'G PIERS PLASTER UNIT HEATERS DRY WALL 7 NO. OF ROOMS GAS OIL _ UNFIN. 3 BASEMENT NO HEATING AREA FULL r � I FIN. B'M'TAREA _ 1/1 1/7 '/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WAILS I 9 FLOORS CLAPBOARDS B _ 1 2 3 �_ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDW'D COMMON ASPH. TILE STUCCO ON MASONRY _ _ STUCCO ON FRAME BRICK ON MASONRY - ATTIC STRS. 6 FLOOR _ WIRING 5 ROOF II 10 PLUMBING GABLE J HIPMANSARD '�JI 3X GAMBREL I ANSARD TOI ETRM12 FIKI r: BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT' DIME&lilol JS"OFi.OT'A'ND bISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF 'B'UI.LDIiVGS: WITH -PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLdT-PLAN. '-ol - 1I11 TILE FLOOR TILE DADO - V 6 FRAMING 1 1 ; HEATING WOOD JOIST PIPELESS 4:URNACE FORCED H T AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. d COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ 1st 13rd ELECTRIC NO HEATING r � I t .yr y� • - 9y. vi -RIOeow _t .Vc'4'EQY i E.rrlfY 717 r e Tired' IWIVM.0 4v0 77> TivE -0e41r rvgr r,✓E oyrccicW iJ IGIC'AT�O pN rNE cer AS 5AO)vv 4 vo rwr1r pers CO.vfUtn/ nvry ra&- 7V.* v 00,- A,010. Avoo&,ee ZO.vive e�avu�rays A'"APIMO ferf,4C.rV OWOAI .treEt''TJ 't /rar ct lfrrr,�►� rv,�r rrrt o�►ru�.vtio iJ.vdr [ Ol•I TCO /N T.yE /rc� "AtOOts IV,*Z IEO A,eW.4. Sit 9 f'L O T Rz 4AI /N Nd. A�OoYEE', /�A.SS' Ae,4. '/V FO,P c o o c, ioG E COs T4'�.rc T/v^/ 1h, /"s 40' ANTE .9v4:5,1 /f f -$,- 7,V/ -f P�.I,1/ .�,p } v�%SES - .VOT F,Ae sov�.oty- aer�,��iv .✓. so�..vo..rriv.�-vr.�I- �E.P.�/.N.IGt' E.Vs.WEE.P�.v6 ,fEPr/!e's ,�rro v ri rE,y feb sf Exrsr�vG .ts-[ os, G L �A•�,E' .s'T ET ,INOOI�EX, .ilASS.��.t��/SE'TTS O/B/O A I A 1 9 f'L O T Rz 4AI /N Nd. A�OoYEE', /�A.SS' Ae,4. '/V FO,P c o o c, ioG E COs T4'�.rc T/v^/ 1h, /"s 40' ANTE .9v4:5,1 /f f -$,- 7,V/ -f P�.I,1/ .�,p } v�%SES - .VOT F,Ae sov�.oty- aer�,��iv .✓. so�..vo..rriv.�-vr.�I- �E.P.�/.N.IGt' E.Vs.WEE.P�.v6 ,fEPr/!e's ,�rro v ri rE,y feb sf Exrsr�vG .ts-[ os, G L �A•�,E' .s'T ET ,INOOI�EX, .ilASS.��.t��/SE'TTS O/B/O A I A FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: COUS4e,Phone ?S-) Sa 13zGok 22 (08 a 5315 LOCATION: Assessor's Map Number F46zi'I f�1 Parcel Subdivision Lots) Street `� +�� Z� �L1' St. Number ************************Official Use Only************************ RECOMMENDATfIIO-N-S OF TOWN AGENTS: 4�re FXV Date Approved V Conservation Administrator Date Rejected Comments Comments Date Approved % Food Inspector -Health Date Rejected y/ Date Approved Sep£ic nspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date e-3U)e L Date Approved U Town Planner Date Rejected Comments Date Approved % Food Inspector -Health Date Rejected y/ Date Approved Sep£ic nspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date ' ,�lalllllllillllllll�������� lull � 1 ci m m n I m o5 m I m m D p m < Z Z � nl m `•�� Ir , - - - - .. __ � .•__.. _ �Nll nNn�H Hina ___ �� I; ' ,�lalllllllillllllll�������� lull z cn m D 0 z T z D r CA CDZ CD O CL r CM 03 n� �v CD CLQ CD O 1-0-07M. . Cc CD CO) .0 CD c7. O C3 MM 03 C) CD O O �F CD a y. CD CA 0 O CCD 0 C CD CW 5'0 C =r-4 O S. V) O Q CCA = d O C m .� y O CD c07 0 Cl) C= C9 d n T ZH a P-0 d O S CD ..► ?M O y CD O CD CO) N� o = 0 W n > > N m n, -0O_ C7 o ccCj O o W � O CO !-1 C• H CD C O N` c c7'o }--� c c nd �3 N e !' N O. CS CO) co Cos H o 'j ca co CD C.O ,.) o . o � o o � • r� '�z'7 co O C/) ��� CO) cc tom: �c=,r,�♦ d` o s oma. C-7 cc., � O a `° C�7 ^ ry 0 Ci ITI p p > Cl)3 z y �i rD p z GO 7 p p n S i7 O 0 O C r Cn rp T] p a x 0" Io 44 0 c Location 3 9%�1/��2G Li2tv��ir %2") / No. Date�/� TOWN OF NORTH ANDOVER ammrmsftp Certificate of Occupancy $ Building/Frame Permit Fee $ ,SSA�HUSEt� 1Foundation Permit Fee $ f��r- Other Permit Fee $ /4 SewerConnection Fee $ ;,Water Connection Fee $ Building Inspector S✓ Div. Public Works PE1611T NCr.. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. I 0 L PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE SUB DIV. LOT NO. �- LOCATION ` , 1 r PURPOSE OF BUILDING '',, /7 007 / olj/ , f elM , OWNER'S NAME P. OWNER'S ADDRESS *: (M „j ,tT�e� �I� i NO. OF STORIES SIZE BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES — SIDES, GIRDERS AREA OF LOT �++'"'v' ONTAGE fy HEIGHT OF FOUNDATION -0 THICKNESS IS BUILDING NE SIZE OF FOOTING X IS BUILDING ADDITIO9 MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE y,�` N' IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER y i:: ). IS BUILDING CONNECTED TO NATURAL GAS LINE y, INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E / 4v 0-0�y'"'• PERMIT GRANTED 4 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 1•- ` BUILDING INSPECTOR !• 'NV1d 101d S30V1d3EI SIHl 'a350dW12l3df1S '013 'S30VU -VE) 'S3H02iOd H11M 'SONia unI3 d0 SNOISN3WIa 10VX3 aNV S3N11 101 WOUA 30NV1SIa 0NV 101 dOSNOISN3Wla 10VX3 MORS-LsnW NOI.L03S SIHl at AON V d (1000 L GIOD3b JNlallns - v � 0NIIV3H ON _ I PlE I OL P Z JIb1J313 110 swoon dO 'ON L SVO S2131V3H 11Nn 0.1.H 1NVIOVb !DNINOIIIONOJ bIV _ Sb3AVb DOOM bOdVA 210 b.1.M lOH 'S10J V 'SW8 13315 WV31S Nbnj bIV lOH 03JbOj DVNbnj SS313dld _ 'Slo:)y -SWB il38W11 1s10f OOOM ONIMH L L I ONIWVII 9 OOVO 3111 21ooll 3111 _ s321n1XIj N6300W ONHOOb 1104 89MOHS 11V1S 13AV21J V dV1 _ `JN18Wnld ON 31VlS _ ANIS N3HJ11A MNIHS DOOM A2101VAV1 S310NIHS 11VHdSV 13SOlD b31VM 03HS 1Vlj 1 XIj Z) 'Wb 131101 06VSNVW 1313 WV0 'XIA E H1V8 dIH 18VO ONiownld OL 1001 5 3bO1b3dns bOOd I I ONIUM 3WVbj NO 3NO1S A2INOSVW NO 3NO1S 'A18 b3ONIJ bo 'JNOJ 3WVbj NO AJIH _I doold 7 'Sb1S J111V AdNOSVW NO AJIbB —� _ F�. 3WVbj NO OJJn1S AINOSVW NO OJJn1S 3111 'HdSV ONIOIS '113A NOINWOJ ONIOIS SOIS38SV O.MObVH ONIOIS 11VHdSV HldV3 S310NIHS DOOM 313bJNOJ SObVOSdOb0 VlD S1001d 6 II sllvm b 'N3HJ11A N8300W WOOb OV3H MVld 32113 1. W.8 ON V3FV JI11V 'NIJ %� 1/1 1/1 V3dy 1.W.8 Ni'j llnj V3sv4 1N3W3SV9 £ — _ _ _ NIANn — 11VM AbO d31SV1d S831d O.MObVH 3N01S b0 AJIH 3NId 'A.19 313bJNOJ 3132DNOD HSINH 101131NI 9 NOUVONnoj Z N011onUISN00 S1N3W1bVdV _— S3JIjj0 —_ AIIWVj I1lnW S31b0!S AIIWVj 310NIS Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE LOCATION "HOMEOWNER" lumber Street Address " Name PRESENT MAILING ADDRESS City Town Home Phone 3 `( q 59101 ection of town Sa8`-7(,Z- 1$z 8' Work Phone 6,8'yS- " State Zip code ";.The current exemption for "homeowners was extended to include occupied dwellings of six units or less and to allow suchhomeowners to engage an individual for hire who does not possess a license rovi ,'that the owner acts as supervisor. (State Building Code Sec ded .,.'DEFINITION OF HOMEOWNER: tion 109.1.1) Person(s) who owns a parcel of land on which he/she reside, on which there is, or is intended to be a resides or intends to ', ing, attached or detached structures accessory to such uone sesix and/orlfa dwell- 1''structures. A person who constructs more than one home in a farm period shall not be considered a homeowner. Such "homeowner shall to the Building Official, on a form shall submit t rm acce to hat he/she shall be responsible for all rsuch ework tperformedgur�dercthe� buildingpermit. P (Section 109.1.1) The undersigned "homeowner" assumes responsibilityfor State Building Code and other applicable code compliance with the ..regulations. codes, b g ons. , -law s Y rules and .'The undersigned "homeowner" certifies that he/she understand he Town of North Andover Building Department minimum inspection rocedures requirements and that he/she will comply with said procedures andr�d ',requirements. ',HOMEOWNER'S SIGNATURE_ ''APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings required to comply with State Control. 35,000 cubic feet, or larger, will be Building Code Section 127.0, Construction ,4 O (P O Z CO) Z ?1 31 O T !n m ?1 17 ?1 f7 37 T 3 0 v In mZ a j w O m m p j w' Vrl O m �• j °1 O •v C Z n Z m � _� 3 W z C1 Z v+ n 0 � e v � W O O C' O � 'C3 B• W O C � .•w C H O POO O ' a � 3 ma H I O eD v) lit O (P O Z CO) a) ?1 31 T !n m ?1 17 ?1 f7 37 3 0 C In mZ a j w O m m p j w' m O m m D � Z T �o j °1 OO rn •v C Z n Z m °' _� 3 O c z C1 Z v+ n 0 v O _ r.. :Tj rn m j -u n'l X —i z m CA ITT! :K= r E/ qq— -a� X : -- - - ------- u 11 III F1 0 C. 1 H38 Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING S��This certifies that ............... ..:.. ��................... C .. �......................:................ has permission to perform ' "wiring in the building of ..............-A..!.......................................................... at......................................................... North Andoer do.Mass,5,- Fee .IA'. :�f�!.. Lic. No. z //......�1 ................................................... .. ..... ELECTRICAL INSPECTOR Check # �� ) (// Commonwealth of Massachusetts Official Use Only ' p 3 Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC , 5 7 CM 12.00 (PLEASE PRINT IN INK OR TY AL. INF RMATION) Date: Q p� City or Town of: I Wjfr To the Inspect6r of Wires: By this application the undersigne17gtvP, two ispr her intentiop to perfgym)he electrical work described below. Location (Street & Nu e) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. 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: Number I. Tons I KW I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Kit 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 OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. 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:) (Expiration Date) Estimated Value 707N�X l Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:Ser-�.gicesLIC. NO.: 153 Licensee: John S. Bassett Signature g LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line) Bus. Tel. No..• 603 594 5928 Address: Alt. Tel. No.: required by law Owner/Agent Signature _ JRANCE WAIVER: I am aware that the Li see does not have the liability insurance coverage normally By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Telephone No. PERMIT FEE. S — Location_��I No. f% Date NORT1y TOWN OF NORTH ANDOVER F41 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ ° TOTAL $ Check 17484 ?'1- �%� Building InspectoLve V TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: 422 Building Commdsiondfl for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 34q MOV INCV 00It W 1.2 Assessors Map and Parcel -� Map Number Number: _J3 . Parcel Number oriAnd oytr MA mq 5 Signature 1.3 Zoning Information: Zoning Dislrid Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Signature Telephone Front Yard Side Yard Rear Yard R red Provide Required Provided R 'red Provided 3.2 Registered Home Improvement Contractor )SA DCC L , Inc, Not Applicable ❑ Company Name c Z5 RLIA V)d e r S V Y `t l� Q� (� � ;Ig 1.7 Water Supply M.G.L.C.40. `54) Public 0 Private 0 + Zone 1.5. Flood Zone Information: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System ❑ SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 1! 1 J LU I i U U I J Lf i LA, T U S _IN U [.I Owner of Record 1-eS �(Jl esILis (Name (Print) 3� q MOYMf"Of 1dGig' gd Address for Service �7 � 25 s 351 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone !' SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: nI&i �0VreiI0-1 Licensed Construction Supervisor: 17s; El �'`) Address Signature I� �� I �cj iNesfi�o�o V Telephone Not Applicable ❑ ��� License Number Expiration Date 3.2 Registered Home Improvement Contractor )SA DCC L , Inc, Not Applicable ❑ Company Name c Z5 RLIA V)d e r S V Y `t l� Q� (� � ;Ig Registration Number i ©� Address t o g 31� 311 l Expiration ate Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check au appillcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify d o, Gleek . Brief Description of Proposed Work: b0 LA 6 CA 6'c cK- � alp r o �C , � UIX I ZI SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Com leted bpermit applicant OFFICIAL USE ONLY 1. Building Of�. oa (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 -7 OSE; - ev Check Number is VVv"L'1�H1J 111VA1LH 11Vt`I 1V ISL' l,V1YIYLL' LL.0 W1jj;tV OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 IIi as Owner/Authorized Agent of subject property Hereby authorize My behalf, in all matters relative to work authorized by this building permit application. to act on 3ignature of owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, u-Cri n l �t e—r 6r i -"li h s 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 and belief ! 2n (er Name n _ of 0-7 — 1) 1 _ 04. Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2No 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CIININEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS.LINE FORM U -LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT leu IU V �ts 112 I -CS 161,S PHONE COY ^ 25 35 LOCATION: Assessor's Map Number 3 0- PARCEL s) . SUBDIVISION ""�� p LOT (S) STREET 3y G NA Q Y b e br i U T Kd ST. NUMBER *****************************OFFICIAL USE ONLY********************************* �RECPMENDATIONS OFJOW"GENTS: ATION DATE APPROVED DATE REJECTED COMMENTS (N n (S % 00 �` ►`am ple,o8�.1 TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTO"EALTH DATE APPROVED DATE REJECTED TH COMMENTSi-- DATE APPROVED � 2. Ile, DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm ff Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Swr Address I2 5 Fl aVici s Rd Cites W ahoor0 Phone* 5OS/ 3 U1 ' r insurance.Co. W a Ch OV l a V 1 sU Y a'YI C� �>°YV 1 C espolic�# 4 2 W c V- 1 LA QS ,�). Company name: Address City: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment -as _well_as_civiLpenattiesiniheform of-a_STOP.WORKORDFRand_afineof.($10.0.00)_a-day-against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby i Signature. Print name Phone # 50O 83 (0 3 1 l Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Licensing Board Selectman's Office Contact person: Phone #: F-1 Health Department Other MORTGAGE .INSPECTION PLAN BOSTON SURVEY, INC. 02-0493 P.O. Bow 290220 Charlestown, MA 02129 (617) 242-1313 .MAIN (617) 242-1616 FAX APPLICANT' IGLESIAS LOCATION.- 349 MARBLERIDGE ROAD CITY, STATE.- NORTH ANDOVER, MA DEED/CERT: 6099-292 PLAN REF: 8395 98.01 NIARBLERIDGE ROAD 1994 (c) Boston Survey Sottwam PREPARED: 05-28-2002 CERTIFIED TO: RELOCATION FINANCIAL SERVICES INC. SCALE. 9inch = 60 feet The permanent structures are a .t1�P&SH of MgSsq ground as shown. They either Conformed to thesetbackon o� C' requirements of the local zoning ordinances in effect at GEORGE�r^ According to Federal Emergency Management*Agency C maps, the major improvements on this prop) rt fall in an the time, of construction, or are exempt from violation e forcement action under M.G.L. Title VII, Chapter 40 A, COLLINS area designated as Zone 'y Section 7, and that there are no encroachments of major No. 41784 Community Panel No: improvements either way across property lines except as�ESStO�Py shown and noted hereon. �Q Effective Date: ip�,2��j�? S y NOTE: Zone C is areas of minimal flooding (no shading). This NOTE: This Is not a boundary or title Insur9nCa survey. This p designation is not bastid on an elevation certificate. by the Massachusetts Board of Registration o1 proley. T engineers and land surveyors, e t CMR dura and use for any other purpose t prohibited. Thi:} I ssiOprepared In accordance to procedural and technical standards for Mortgage loan Inspektions as adopted •. used for recording, preparing deed descriptions, or co tructlon. pan is notmo be Customer's Full Name Purchase Order No./ID (Optional Home Depot/installer Use only) r0L 1016,1&L Servide Address �v #*°�� firiie L)BpOt ApprO'�al`t 2 4a � Re�hewT/(pp p�ai Rat§ Ar"'toTBflNaietlotts fI'I�W����©��®©��■■■.■■. 'DIY`/ l ����� .—.Customer's Daytime Tel. No.�� # � � �Csi�&. �y � ,�,p"mer's Drivers Lic. No. or State ID No. Required Attachments to this Installation Agreprindht ❑ Installation Diagram ❑ Instal►ation. Specifications El State Law Addendum* ❑ Oregon Only: Lien Information Addendum J�Q*Includes Home Depot's Contractof>Licensing NosJBonding Information tt� Primary Payment Method:Ch&klMoney0 der F om'eDpipot Caffto eam rovement Loan AMEX'` Discover MasterCard VISA Prima ryCard Number:* Secondary Payment Method. d tiorrle Depot Card/Hoffir ' l)provement Lban AMEX [� Discover []:MasterCard ❑ VISA g `tk', .1 Seconds Card Number:* �' `t Secondary �� f� expiration: *If paying by heck, print name of Yourbank, bank contact 0rs6n,ind batik te�pitb&num,ggber for Ob*ks , of verifying sufficiency of funds (if requested): IN If Your transaction is secured by an interest to Your property (sudif aifho�he bqu,iyr)0M,'sr mortgage, please fully describe it here: Initial Payment/Deposit: $ « o o-IM"muin allowable Initial Pa ment/De oslt limited m so rie states See Your State Law Addendum for details. 0 w �t! p .. Second Payment: $ Apphcabl�only If thlstransactlon wilt be pafdm Paris Third/Final Payment: $ +�Appltcableonlytfitistratssion will bepasd tri pmts rias only upon installation's completion. Sales Tax: $ _ if applicable. Sales tax ray'nbt apply tri all staei;. Total Payment: $ u -.-,Includes all app0i1cable discounts rebates, and taxes. Excludes finance.charges. Payment schedule subject to change; If this trAsaction is financed via 0 Home Depot Cardlf tome lmprovernAt Loan You agree Your scheduled payments will be automatically charged to Youf.designaid'account(s) on�r-abou)tne itadicated due dated Hare Depot Will try torchargea I scheduled payments to your Primary Account but reserves the ngl t to charJj°e payor nts tots y f the�acco hot listed abo gin tf corder it deeol neC Ssary. You must notify Home Depot or Installer no later than tl�n' (10) days prior to the next scheduled payr�ientt late if You JAt to'Ji- ke 4ibrnat arrangements to pay. Credit card transactions and home improvement loans, irlcfuding Home Depot Con"sumer or'CbMrnercial G edit Card transactiok and Home Improvement Loans, are further governed by the terms ani conditions ofYour cardholder orloan agreement which is separa#e from this Agreement=, Installation Schedule Please Note S#artandfinis6dates reapprox►mate`-"' m clla�tgefHomeDepotaddlnstallerarenot responsible fordelal±s caused by- events beyond their coiatrol including but not Gimped to°acts of nature, acts of governmental Start Date: en"tlfies _delivery delays or Inability of suppliers to deliver, strikes Your financing, incorrect information from You, Finish Date: _ / I �° / hidden or unfofeseerlooh" ;tions at Your servioe eddress; Change Orders; or Your noheompliance with this Agreement. Acceptance and Authorization: "You`' means the customer identified above. "Agreement" means this At -Home Servicers"." Ame ImDrovement Aareemenl between You and Home DepoiUAlnc {:trteepot")fich IhclLfdes this`page"the General Terms antonditlons appearing on the reverse of this page, Installation Diagram and Specifications, State Law Addendum and any other documents (as listed/checked above) attached to or otherwise made a part of this Agreement. By signing below, You authorize Home Depot to arrange for an independent contractor (licensed and insured as required by Home Depot and applicable law) and the contractor's employees, agents and subcontractors (collectively, "Installer") to perform the installation services ("Installation") specified in this Agreement. This Agreement supersedes all prior written or verbal representations by Home Depot, Installer or anyone else. Do not sign this Agreement if blank, incomplete or missing any required attachments. (If this is an in-store sale, Installer's information may need to be provided to You later.) By signing below, You acknowledge You have read, understand, and accept this Agreement in its entirety. You further acknowledge receiving a complete copy. Keep it to protect Your legal rights. Accepts L, 1 S -S C st rs ignature Dat 1 Installer's Full Business/Trade Name (if knownlavailabie at time of sale) Installer's Lic. No. (if known/available at time of sale) and, in VA only, Class/Speciatty Sale Consultant's ID/Lic. No, (It applicabie—not required in all states) For questions or assistance, please call: or contact your local Home Depot Store Home Depot U.S.A. Inc., 2455 Paces Ferry Road, N.W., B-4 Bridge,. Atlanta, Georgia 30339 NS -750 (8/20/02) DISTRIBUTION: White—Home Depot Copy Yellow—Customer Copy Pink—Installation Vendor Copy COMPONENT LEGEND 1. Door 5. Stair location and level 9. Horizontal Starting Point (HSP) 11. Corner of the house: 2. Step Pads 6. Any landscaping obstacles 3 C, 1"k 1, ft.!�_ in. 3. Railing style and location 7. Marking of site utility lines 10. Vertical Starting Point (VSP 4. Lay Pattern 8. Deck Accessories Left: Right: n try tri str Checklist' Indicate North: t" ME x1 t + ` O'Conflrmatibn of r7i &nal tjrpe F� 1 nnatinn of nvfcrinr elnnrc Sm Approximate Panel Size: 1111 Scale: 1 Square =1 Foot Remember to note any trees, power lines, or obstructions. Include dimensions. u L_I LOCallOrl 01 00r10rele 10011r195(, ❑ Railing styles 1I y T 1 ❑ Site accessibility ❑ Location of step pads and stairways ❑ Earth leveling or grading needed ❑ Location of underground sprinklers, plumbing, electrical ❑ Electrical access ❑ Referenced VSP is clear of all window, downspouts, other For questions or assistance, please call: or contact your local Home Depot Store Home Depot U.S.A. Inc., 2455 Paces Ferry Road, N.W., B-4 Bridge, Atlanta, Georgia 30339 NS -750 (8/20/02) DISTRIBUTION: White—Home Depot Copy Yellow—Customer Copy Pink—Installation Vendor Copy t Material Information Decking Material Type alX, Mat�e..zhn� Pressure Treated: ❑ CCA' ;'' Pressure Treated- ❑ ACO/CBA : ❑Composite .❑ Cedar=.: ❑:Redwood .: Size: Approximately Ft long Projected but approximately Fit Stairs:. One level: # of steps: Multi-level: # of steps: =. Dimensions Number and size of step pads: a f Kick plate sizer Style t.( s Lay Style: (see design Straight ❑ g Dlarh�ona[, Get torn Lariy Walkwa Size ❑, L.J dttg- Slze,;c„ y: gdd.for custom drawing) y6 Railing,style: (see design E] Picket . ,, ❑ Cofornai-r ,❑Turned Spindle ElChlppendaie (Custom) E]SunBurst (Custom). rid for custom drawing) 9 g) _ .. u, Railing dimension: Linear ft Ut' 'Special note to Customer: Certain types;,of pressure-treate approved the attached Consumer Safe 4n'formation Sheet fc EPA's website at http://www.eDa.aov/bestlizens/cca Other Site Information (circle apj of 'ate otmati nl Water: Public or Well r r , txk* s Concrete penetration for posts: Yes or No Hoes �s,� Will chosen site need to be cleared, graded rleveled des Deck Accessories Information (circli dopropnatb information) CP Cf wood.requires special handing 7 en a Protection Agency (EPA) has mood treated with romte,er Arsenate. Additional information is available at )nsumer safe `h { f' to fireplace: Yes or No ricity : Yes or No Bench Seats alX, Mat�e..zhn� x�k s x DlmetislonS ': ..: X; , oma- ,z.}. ,. h {o t. trw i S Arbor Material Dimensions Flower Box M tde I' Dimensions _" Lighting, Style t.( s n NuMber� f Units OVA ti Gates tenal [ �' SteVAila w. ,kltvftl Other Accessories: (see design grid for custom drawing) -i"@ S. +�6' [ Yy # 7•-imv'%. "a�� p7�i$ it Y 41A '25 L «ssy n.:..q r'� xwj as �5..k ani, _} Y1 A. # � Sp«- rlfhcr Snoeiml Ine4rnr4inne �t. p ` `° "' `� Sales Consultant Use Only a11fl 4 g ❑#�R ❑ IH6 ❑iii (�gPOT3i0A P�epareyd By t l .. i yY"t"' A- ti4 '� f; k iVi?V ❑ ❑CORA ❑ C,OT1T CL Status Code:" 1�F o- E)9 FS ' WSNR cc nh 41.1. Saes foliaw`U Action % Pktone Gall ''` $ Siie Vlstt f ir�aft ❑ S ❑UPS .] SPECS ❑ P F Date for Follow Up ` f` r - For questions or assistance, please call: or contact your local Home Depot. Store Home Depot U.S.A. Inc., 2455 paces Ferry Road, N.W., B4 Bridge, Atlanta, Georgia 30339 Ns -750 (e/20/02) DISTRIBUTION: White—Home Depot Copy Yellow—Customer Copy Pink—Installation Vendor Copy DECK INSTALLATION SPECIFICATIONS ADDENDUM, THE INSTALLED DECK DIVISION FOR THE HOME DEPOT DES GNEA.DECK® AT-HOME CALL 1 -800 -USA -DECK INSTALLATION SERVICESADDENDUM (That's 1-800- 2-3325) Customer No.: q$O I''MLA Sales Coordinator: e�P �tr-'may Date: 3 Page 1 of 2 Cr1or s j9 -W---5/4 5 CUSTOMER'S NAME FIRST, MIDDLE INITIAL & LAS 97,f. XT -ri HOME PHONE 75 3-,V -Coyer NAME & OFFICE PHONE: NAME & OFFICE PHONE: wvn ADDRESS CITY STATE ZIP CODE FAX # E-MAIL INSTALLATION ADDRESS ADDRESS (IF DIFFERENT) NEAREST -CROSS STREET BUILDING PERMIT JURISDICTION Your Designer Deck", as specified below, will be fabricated and installed in accordance with the design specifications described in this addendum: DPSIGNER DECK- SPECIFICATIONS: (5/4"x4" Radius Edge Decking Standard Grade) Your Designer Deckewill be: T"dl Parquet Module Floors_ In System wl Invisanaile ; or ❑ LX Strai t Board Decking Face -Nailed (Include LX Addendum if this box is checked) Your Deck will be approx. -_ feet long and project out approx. feet. (See Deck Drawing on your contract for exact size and configuration). Your House Plate will be FASTENED to the house and Deck posts and a cantilever beam will be located and installed, within 2 feet of house foundation to support the House Plate. All other Deck posts will be located and installed as per prescribed building codes, the Permitted Blueprints and/or as best determined by the Crew Chief installing your deck. List All Custom Sizing Specifications (length, projection, etc.): SPECIAL INSTRUCTIONS Horizontal Starting Point (HSP): ❑ Tight under t oor threshold Other: Vertical Starting Point (VSP) from ❑ LEFT 2r RIGHT Corner of house: in. (identify on a Photocopy of the Plot Plan) Referenced VSP is clear of all windows, downspouts or other obstructions? ❑ YES ❑ NO Explain: Deck Elevation (Approx.):_, –12—�L_ _NoteUtilil Obstructions. RAILING SPECIFICATIONS: I Sunburst Rails: TotalItof4'sedions= Total frof6'sections = STAIRS: Multi -Level, E -Z Glide, Corner and Step Pads: The stair system foryour Designer DW, it applicable, will be as specified below and as described on page 2, which is attached hereto and incorporated by reference herein. All stair systems include low -voltage stair rail Lighting Package (Customer must provide electricaloutlet)and 3112'Kick Mates standard. The stair system(s) for your Designer Deck" will be: Type 1� 1C.�/-O'• llr` 1 � Approximate Elevation � S' ^ Include Optional 8' Kldk Plates; Type Approximate ETevation ❑ Include Optional 8'Kick Plates; Type Approximate Elevation ❑ Indude Optional 8"Kick Plates: Other LANDING & WALKWAY: Landings and Walkways will be as specified below, it applicable. and as described on page 2, which is attached hereto and incorporated by reference herein. ❑ Landing: Approx. Size z . (circle): ATTACHED FREESTANDING TRAPEZOID ❑ Landing: Approx. Size . (circle): ATTACHED FREESTANDING • TRAPEZOID ❑ Walkway:Approx.Size x Location: DECK ACCESSORIES: (please circle appropriate products) The following deck accessories are available: Bay Extensions • Bay Wrap Arounds • Corner Wings • Rail Gates (to match the railing style except the standard -style gates will be made of 1 x 4's instead of 2 x 2 or 2 x 4) • 4 x 4 Corner Planter Box- • Rectangular Planter Box Rai mount Planter ¢Q • Railback Bench • Open Back Bench Rail Table • Sun Trellis • Beam Trellis • Underskirf (circle one): Lattice T -t -11. Specify Deck Accessories and Sizes: it ADDITIONAL WORK: circieapplicableInformation) Custom Cuts • Custom Fill-in v I - ppvious wood deck, concrete landing/pad, or steel landing (circle one:) WITH/WITHOUT haul -away. • Save-a-RooforAwning Excavatio (circleone:) WITH/ haul -away •Flashing • Post Penetration th�concrete/aspha rdeo e:) WITH/ WITHOUT patch -up; Other(specity below). Your Designer Deck' will require the following AddrtionalWork(please bespecific): SPECIAL INFORMATION: (Please do not sign this agreement it you disagree.) It after the old structure leg ., prevlous deck, concrete stoop/steps, etc.) is taken down and any unforeseen damage Is discovered such as rotten wood, cracked or chipped masonry/bricks, and/or any other structural or cosmetic work that must be repaired or replaced before the new deck can be installed, there will be additional charges. The Home Depot does not claim or imply to have lumber that is free of knots. The size, number and tightness of the knots in each grade is determined by industry grading standards. Treated wood has natural seasoning characteristics that can cause it to show signs ot: checking, splintering, warping, cupping, bowing, splitting, raised grains Vianddiscoloration with age. Photographs that you may have seen are not actual reproductions of wood color and quality HPME OWNER ASSOCIATION (HOA) APPROVAL AND BUILDING INSPECTIONS p Whenever HOA approval is required, the Contractor will provide Purchasers) with an HOA packet that explains the details of what work is to be done. ll is1he Customer(s)'s responsibility to submit the packet and formally request an approval lot the work to be done and to keep the Contractor informedas'to'' the approval status. As your Contractor we will be fully responsible for total HOA (Home Owners Association) compliance before, during and after _installatio. It is likely that your county/city building inspectors will require us to perform additional work not designated on your contract and/or - -- - - Building Permit. As we are already familiar with this possibility, it is our standard policy to perform this additional work at no additional cost to you. It is agreed and understood between the parties that is this Addendum and original Agreement along with other signed addendums constitute the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms of this Addendum. Other than as specifically indicated herein, all the terms and conditions of the Agreement will remain In lull force and effect. Buyer(s) hereby acknowledge that Buyer(s) has read this Addendum and has received a compleI d, signed and dated copy of this Addendum on the da written below. Sal Ws=NaPame) es Consultant Signature Date stomer(s)'sN (Print Name) r Customer(sV Signature Custom r(s)'sSpouse'sorCO-Customer's Signature FORM p HDODOB03-Rey 1104 WHITE - THE HOME DEPOT COPY • CANARY - CUSTOMER COPY • PINK - INSTALLATION VENDOR COPY �ht-24�2m� 01:41 PPI MARY DAVIDSON 9766856990 O �a I . U-111 w *:i fir. F t Z "`' a °G ` R w Vol c dWr Ar lid m� e� m —v CO) 10 C d 'O O c� z t=i) E O =. a� c ? 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