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HomeMy WebLinkAboutMiscellaneous - 81 BERKELEY ROAD 4/30/2018I +� N Y O m m i � � m' 0 0 o n b � i �'}_ 1 r 9257 , Date NORTq •��o TOWN OF NORTH ANDOVER it •`- "' .... -'• Ot PERMIT FOR PLUMBING ,SSACMUSE� This certifies that .7. /io.ao�. .�.. ........ . has permission to perform. plumbing in the buildings ORO �� ................... at .... <.'(ON 1 �... �,qS. U........ North Andover, Mass. Fee\ . �' ... Lic. No.... PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Q e� K' L) Date ' oZ Permit# Owner 1 ne_ Amount New rl Renovation ri Replacement Ed Plans Submitted Yes 0 No FiXTi Tile ire (Print or type) �' ` Check one: Certificate 1 Installing Company Name 1%1" 1)0 yy ,q � Corp. Address i . y 9 t�h ► C' (�G( �Partner. ►9 O J F 7 Business Telephone 9 �6 _ 20 _SDEitm/Co. Name of Licensed Plumber: Y -Q-- o11 r Insurance Coverae• Indicate theince coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: L the undersigned, 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 installations performed under permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts state Plluumbing Code and Chapter 142 of the General Laws. By. Signature or Eiceusviuum er Title Type of Plumbing License City/Town /her} PL JS -3/0 rcense um �r Master Journeyman APPROVED (OFFICE USE ONLY G //(-) a./a ora )j tk/ e-7 5�7L The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ..600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: ,o,-,.,/.. City/State/Zip:_I w QCs 1, ":A At q�y Phone #: 9 `�2t 7T% J n 13 Are you an employer? Check the appropriate box: I. L3 l am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole have hired the sub -contractors listed proprietor or partner- on the attached sheet t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other - --- — - - »:��, �,,, ��� �e secnon Qe!ot•• s�^�= nb + ei wrrKeT' c ,m; e saLion policy info- r boa. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 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 cer& under the pains and penalties of perjury that the information provided above is true and rnrr-0 ll\ __T 1, -7T Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners,. are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department. of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Inv'esfibations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 ,"mm,.mass..gov/dia `'1 ? `U2^ L ? co o • CL S z Q Ale Jul bi U {jYy,J��r� m r LL `'1 Date.CS .^�� ....... 0 � ry° o� �`' °� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION } This certifies that .. ,� �� �� .. .' /�� . �. ? `.................. has permission for, gas installation ...1 G ` �'`�'_ in the buildings of .. C:r: at . Y-/..... /7. �n 7.. 1-....... , North Andover, Mass, Fee... ° rLic. No.. t.` �.1 �.. -�.!. .......... GAS INSPECTOR Check # ^%L 7 1- 7271 MASSACHUSETTS UNWORM APPUCATON FOR PERMIT TO DO GAS FfrnNG (Type or print) Date P7 --/d NORTH ANDOVER, MASSACHUSETTS Building Locations VPW e Permit # _ Amount $ le K OF S 0 Owner's Name . New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type)4ANQ ` �a " Chec Co,nCertificatg� st ll ng Company Name14��'G Address 9 �S e 8 ❑ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Cv [Nave SURANCE COVERAGE Check one: a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked .yes, please in ate the type coverage by checking the appropriate box. Liability insurance policyED , Other type of indemnity ❑ Bond ❑. 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. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information 1 have submitted (or enterea) to aoove appncanon are true ana accurate to me best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in., compliance with all pertinent provisions of the Massachusetts State Gas/Cpde apter}42 of the General Laws. y: itle� OVER (OFFICE USE ONLY) bnature of Licensed Plumber Or Gas Fitter Plumber / G A ❑ Gas Fitter License Number ff_teaster ❑ Journeyman � a a w z a U m w U o x z o W a z z wHc" z �z W — F w � �w , a - oz ow C�nz o z a SUB -BASEMENT ASEM ENT ST. FLOOR ND. FLOOR D. F L O O R 4TH. F L O O R 5 T H. F L O O R 6 T H. F L O O R 7TH. FLOOR STH. FLOOR (Print or type)4ANQ ` �a " Chec Co,nCertificatg� st ll ng Company Name14��'G Address 9 �S e 8 ❑ Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Cv [Nave SURANCE COVERAGE Check one: a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked .yes, please in ate the type coverage by checking the appropriate box. Liability insurance policyED , Other type of indemnity ❑ Bond ❑. 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. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information 1 have submitted (or enterea) to aoove appncanon are true ana accurate to me best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in., compliance with all pertinent provisions of the Massachusetts State Gas/Cpde apter}42 of the General Laws. y: itle� OVER (OFFICE USE ONLY) bnature of Licensed Plumber Or Gas Fitter Plumber / G A ❑ Gas Fitter License Number ff_teaster ❑ Journeyman Location No. ��'2 " Z. Date NORTq TOWN OF NORTH ANDOVER F R 9 • Certificate of Occupancy $ o, a SCMUS Building/Frame Permit Fee $ Z1� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # S7/ r� 2488 9 .Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 9% Date Issued: /'2Ilk IMPORTANT: Date Received must complete all items on this LOCATION I?, / � Print PROPERTY OWNER C&2 4 -SQ Unit # Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Res' ential Non- Residential ❑ New Building VOne family ❑ Addition ❑ Two or more family ❑ Industrial ffAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition El the ®S ptic�0 lam D .Wa er~ shed District <- ®Water/Sewer DESCRIPTION OF W OKK TU BE PhF%1r UKIVMli: w c_ Lt.,��/ �l/�=,✓ �� o� mak. t l/ �e c.� �'irr 7� (Identification Please Type or Print Clearly) OWNER: Name: 4- e -N"' r,., U Phone: Address: 01-ey 12 'c__ ti V4—I-61--C _. CONTRACTOR Name: Z474,n� J� % — Phone: too 3— ?6= 9 67? Address: JVQ— 9Au a e'd / / i Supervisor's Construction License: Exp. Date: Home Improvement License: &h 78 �;' Exp. Date: 6 3 Z24 3 ARCHITECT/ENGINEER Phone: a Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. FEE: $ Total Project Cost: $ 1��" ��%� Check No.-: Receipt No, NOTE: Persons contracting with unregistered contractors do not have ii 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording -- must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Dimension Number of Stories:__ Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Y DAL ChapteNGER ZONE LITERATURE: Yes No MG 166 Section 21A—F and G min.$100-$1000 fine DocOuilding Permit Revised 2011 June/mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ ' Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ Stamped Plans ❑ Swimming Pools " El 4 Food Packaging/Sales 0 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS y� HEALTH Reviewed on Signature a COMMENTS jl �I l - il Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes IN'Planning Board Decision: Comments �F I Conservation Decision: Comments ater & Sewer Connection/Signature & Date - Driveway Permit i DPW Town Engineer: Signature: . pli �_ Located 384 Osgood Street FIRE DEPARTMENT; -';Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date. ; COMMENTS cd G4 o cnU a xx o m G ��2� O c� w � o � r� cn w x w w z w A m o cn v Q cn c c C c c CZ .c H O c rcc C •52 V C cc M 6a c � O O c ol EQ .eo _ C H E c !q ` o �D cm c CS � 3 «. m r cm m co, Sco v: a \L c VJ N CO m N m \ ` :5:5 cm c,.,_. c 'Z .•m c co R! ) ZO _ cm co.o c Q m i� mC •B = m N H 4- CA Oma ~ D W c 4::S-,= . 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THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. T( IS 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 policy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-404-995-3000 Marsh USA, Inc. CONTACT NAME: PHONE FAX No Ext : CAIC,No): EEAD RL homedepot.certrequest@marsh.com Two Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 INSURERS AFFORDING COVERAGE NAIL# INSURER A: Steadfast Ins Co 26387 Fax (212) 948-0902 INSURED INSURER B: Zurich American ins Co 16535 The Home Depot, Inc. Home Depot U.S.A., Inc. 2455 Paces Ferry Road NW New Hampshire Ins Co 23841 INSURERC: �F INSURER D: Illinois Nati Ins Co 23817 INSURER E. NATIONAL UNION FIRE INS CO OF PITTS 19445 Building C-20 Atlanta, GA 30339 INSURER F: Illinois IIIIlOn Ins CO 27960 CAVFRAC.FS CERTIFICATE NUMBER: 22552223 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POUCY EFF MIDD POLICY EXP M/DD LIMITS A GENERAL LIABILITY GLO4887714-01 03/01/1 03/01/12 EACH OCCURRENCE $ 9,000,000 -i- DAMAGE TO 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES EaENTED occurrence $ MED EXP (Any one person) $ EXCLUDED CLAIMS -MADE a OCCUR PERSONAL SADV INJURY $9.000,000 X LIMITS OF POLICY XS X OF SIR: $1M PER OCC GENERAL AGGREGATE $9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 9,000,000 $ X POLICY PRO LOC B AUTOMOBILE LIABILITY BAP 2938863-08 COMBDtSINGLLIMIT Ea x 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS $ X SIR AUTO P UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ C WORKERS COMPENSATION wC061967352 (AOS) 03/01/1 03/01/12 g WCST OTH- AND EMPLOYERS' LIABILITY YIN D ANY PROPRIETOR/PARTNER/EXECUTIVE WC061967354 (FL) 03/01/1 03/01/12 E.L. EACH ACCIDENT $ 1,000,000 E OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) NIA WC061967353 (CA) 03/01/1 03/01/12 EL DISEASE -EA EMPLOYE $ 11000,000 EL DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C workers Compensation WC061967355(KY,MO,NY,WI, )[)3/01/1 03/01/12 F TX Employers XS Indemnity TNSC46244151 (TX) 03/01/1 03/01/12 Occurrence/SIR 30M/1M E workers Compensation WC1192378 (QSI) 03/01/1 03/01/12 SIR IN DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U mon: space is required) CERTIFICATE HOLDER . CANCELLATION ACORD 25 (2010/05) Jthornton_hd 22552223 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PLANNING DEPT 1600 OSGOOD ST. AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 USA ACORD 25 (2010/05) Jthornton_hd 22552223 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t6 _0 U G N co to O I- 0. N Qcv) O N C N C O O O R F %o NX a. Qi W w 'C W L L .g 'C ori d L u U � Z U) WQ M aw� w J U C? 0w< WQa-Z 5U_ -T VIuz 0cLNQ O c� 0 O ell U N a 2 ca U A N F � G � O 6 Q. cm7 F 0 d U z C' m U M _ Z Lo n N ,. d C UJILU M" ZL lk LU ~2 O LL I'MO v O d W n ¢ a z Lu O 2 N Q ADDITIONAL INFORMATION PRODUCER Marsh USA, Inc. homedepot.certrequest@marsh.com Two Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 INSURED The Home Depot, Inc. Home Depot U.S.A., Inc. 2455 Paces Ferry Road NW Building C-20 Atlanta, GA 30339 Workers Compensation Continued: DATE (MMIDDIYY) 08/01/2011 COMPANIES AFFORDING COVERAGE COMPANY F Illinois Union Ins Co COMPANY G COMPANY H Carrier: National Union Fire Insurance Company Policy No.: WC1192379 (MA) Policy Dates: 03/01/2011 ? 03/01/2012 Limit: $1,000,000 SIR: $500,000 *** ROME DEPOT INSUREDS*** Home Depot U.S.A., The Home Depot, Inc. Entity List Chem -Dry Limited Harris Research, Inc. HD Direct LLC Home Depot Installation Services, Inc. Home Depot USA, Inc. dba The Home Depot THD At Home Services, Inc. dba The Home Depot At -Home Services THD At -Home Services, Inc. The Home Depot, Inc. The Home Depot, Inc. Home Depot USA, Inc. Your Other Warehouse, LLC TOWN OF NORTH ANDOVER PLANNING DEPT 1600 OSGOOD ST. NORTH ANDOVER, MA 01845 USA MARSH USA INC.BY _ _ Page 2 1, ---------------------2 7q 4 �$ Wig. 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