HomeMy WebLinkAboutMiscellaneous - 9 WALKER ROAD 4/30/2018 (6)Location 6VAIKER Pi 1)'V(4
No. a- Q- Date —/o7- D o2
TOWN OF NORTH ANDOVER
+ ivsat; . Certificate of Occupancy $
SS cHusE<� Building/Frame Permit Fee $ 3
Foundation Permit Fee $
Other Permit Fee
TOTAL
a9(5 -�-
Check # 3 O I LP
157. 9
$ � D
l Building Inspector
1.1
1 V
Property Address:
W a 1 k,�--0.
i1 �Oy Ly V
5(S
/�
i { Q V i g y 5
1.2 Aueson Map and Parcel Number.
_
mw Nunes
? )
,
Paroel Number
1.3
Zoning Dir+id
Zoning Infornutioa:
1.4 Property Dimenskes:
--
1.6 SURDING SETBACKS ft
Front Yard .
Side Yard
Rear Yard
R
red Provide
Fred Provided Rcquired
Provided
1.7 WAK &Wy ALQLC.40.. S�,j -
o i • .Il
ls. Fbo4 Z.aas lafoa mer": t.i sewew�s
Za 0awww Flood 7.oae o Mmicipw a
i)ipes�l Syatrm
os ser. Disomg system o
SECTION Z - PROPERTY OWNERIg IUVAUTHUMIZ&V At KRIF
2.1 Owner of Record
Name (Print) .Address for Service:
Con�ru- ' 3631 O18L4
Signature Telephone
7Print' l Address for Service:
.V - 500 -1 S6 -668bV•ibrc,s�s�e•r , M a
g' tort Tai
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor. Not App&able C
Licensed Consul„ action Supervisor: — —
License Number
Adds` t
Expiration Date
Signature—_^Tekp6ate .
3.2 Registered Home Improvement Contractor nl l K e. '� e D a RI y b 1 Not Applicable 0
VAX 50 6- 3�i
Company Name
Registration Number
3%1�._C2,c e.e -L�,,�o�d .S W oC-C. , a . 01 ��
rAddress
E*mfionDace
Si nature ek hone
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6)
Workers Compensation Insurpace affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildi it.
Signed affidavit Attached Yes ........ No ...... .❑
SECTION 5 Description of
P Workckmm*k at#
New Constriction 0
Existing Building 0
Repair(s) 0JAIterations(s)
Addition 0
Accessory Bldg. 0
Demolition 0
Other. : 0 Specify
Brief Descrintion of Proposed
Work:
1 Y�\OW S 00, .STC LTV f F, _
t -V C,vs__
_o
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollar) to be
Completed t appficant
I. Building Z' S d0 ,pa 7(b)Eadmted
ding�Perntit Fee
2 Electrical TqW Cost of
Construction
3 PIMEtN Plum'Building Permit fee (o) x (►) 0'r4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 00 . F6 I Che4 Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,_� as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Sigmtwe of Owner � _ e D a te
SECTION 7b ®WNER/A_i7THORIZED AGENT DECLARATION
I._as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application true and accurate, to the best of my knowledge
and belief
PINNaveI"\ �L,
Si�W a of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1 2
SPAN
DIMENSIONS OF SILLS
DfM ENSIGNS OF POSTS
DR ENSIGNS OF GIRDERS
HEIGHT OF FOUNDA11ON T
SIZE OF FOOTING
MATERIAL OF CFMVNEY
IS BUILDING ON SOLID OR FILLED LAND _ _�_
C. etLo 2.152-
�LQi'1 ,yLS r,0
��jIDZ
HOME IMPROVEMENT INSTALLATION CONTRACT
Branch Name: iULi•.� i'aJ�YLPm)NDate: N -0 z— Sold, Furnished & Installed by
1 -, ; _• i , The Home Depot Installed Sales
Branch Number: r Job #: ` %+ 345 Greenwood Street, Unit 1 Worcester, MA 01607
Toll Free (800) 657-5182; (508) 756-6686; Fax: 508-756-2859
Federal ID# 75.2698460 RI Cont. Lic# 16427 CT Lic# 565522
MA Home Improvement Contractor Reg. #126893
Installation Address: 'WaLkE-IC, ?<'..t:Ar #� 1t�J2ij t1W��'� fes. j'✓O %jf('i j
City State Zip
Purrhaspr(c)- SCfi- I)rivpr'c Lirpncp• Wnrk Phnna: 114— Ph—,
�tr,%•If?" r .:ZL %�� yYt�rlP,t�
(��=� � !]`l Q�G-�fi'r{'�t-i 5 `!/�Lr+d^'�-^.S�i �'�
Home Address:
(if different from Installation Address)
City
State Zip
Proiect Information I/We ("Purchaser"), the owners of the property located at the above installation address, offer to ,
contract with The Home Depot ("Home Depot") to furnish, deliver and arrange for the installation of all materials as described
on the attached Spec Sheet # 1.7 t.^ i Co , incorporated herein by reference and made a part hereof.
Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it
cannot perform its obligations due to a structural problem with the home or because work required to complete the job
was not included in the contract.
SALE AMOUNT $�/ '
CONTRACT
BALANCE DUE a
ON COMPLET S -
*25% of Contract Amount pon executio-
this contract (unless project is rough
Chevy Chase, in which case no deposit is required).
Indicate Payment Method For
- BALANCE DUE ON COMPLETION
DEPOSIT PAYMENT OPTIONS
(Subject to fund verification and/or credit approval.)
1. Check, Cashiers Check or US Postal Service Money Order
(made.payable to The Homepepot),.-`�
!
2. r it Car * and/or other payment options - Circle One Below
isa Mastercard Discover American Ex -press A�F,r;,; ✓.1 r. Ct.
u+� a Vt 1
Hori'itf improvement Loan ome 15epot Credit Card)
Available�^Credit: $ ( HIL & HDCC ONLY)
Acct#: ��>J r%L� -�tI1 Exp. Dale: y
Name as it appears on cmdR�:_ %-i:Flp o b m Iy R5'• E: i.i�
'By tpt y/oy�Isignat a below, I/We agree to alloyv The Home Depot to charge the
abpvr",
renceredit car forith mouotiiocaled b C.
j
fgaolitildersSignature Dates e
If this is a finance transaction, the agreement for financing is contained in a separate document, which is incorporated herein by
Reference, and made a part hereof. At -Home Services Credit/Loan Application Ref. #
Purchaser agrees that, immediately upon satisfactory completion of the work, Purchaser will execute a Completion Certificate and pay any
balance due (unless the job is financed, in which case, upon submission of the executed Completion Certificate, Home Depot will be paid in
full by the lender). Purchaser also agrees to be jointly and severally obligated and liable hereunder.
For Mass. Residents Only: Contractor, at owners expense, shall procure all permits required by law as follows: Owners who
secure their own permits will be excluded from, the guaranty fund provisions of MSL Chapter 142A. Unless otherwise noted
within this document, this contract shall not imply that any lien or other security interest has been placed on the residence.
Entire Agreement : This agreement and its attachments, including any financing agreement, contain the complete agreement
between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep
it to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project
before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed
by the owner prior to the actual completion of the work to be performed under the contract.
You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of
Cancellation for an explanation of this right. There will be a service charge equal to 25% of the contract amount if the job is
cancelled by Purchaser AFTER the third business day.
BY MY/OUR SIGNATURE BELOW, I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR
CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT AND RMA HOME SERVICES, INC., A HOME DEPOT AUTHORIZED
CONTRACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING
AGENCY AND RELEAS1y.ZHEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS.,
Y//
SUBMITTED B {� - /��' `'� Date:
O
ales opsultant
X ACCEPTED BY p
Homeowner
Date:
NOTICE: ADDITIONAL TERMS, CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT
White -Branch File Yellow- Customer Pink- Sales Consultant
10/15/01 SA -SC
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The Commonwealth of Massachusetts
Please Print
Name: c V e,1�T
re.. 1` ► �- ISG r 1 v 4 2. Ct
Location: 41k�4 Q_00,'k
ci A n Ly zr ' RfSone b8 $ - 3
am a homeowner performing all work myself.
01 am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working '
oY g on this fob.
company name: Q. MA• 4 o nae— S trr �,c e S Tn c ..
Address ,1 ZOO
City: r [T 14 w T4 P�1ot18
► str nce ,y;r� �r�c� S„rE. C.o. ^'nC . OLS- 00000503
CQmlaany name:
Address
city: Phone #
Insurance Comom
Policy #
Failure to secure coverage as nxp*ed under Section 25A orMGL 152 can lead to the WpoSifion of criminal
and/or one years' imprisonment as welt as civil penalties in the form cif a STOP' WORK ORDER and a � of�00 00 a dam � to $1.500.00
understand that a copy of this statement may be f0w arded to the office of Ln I ) y against me. t
ves8gabons of the DLA for coverage verification.
f do herby certify u the pains and pens ftes of perjury Drat the kWbrrnatfon provided above it true and correct
Signature I Q
trate 7 • I • b Z
'Tint name „�,� V �R, Phone # SdS -7 b 4686
liicial use only do not write in this area to be completed by city or town official,.
❑Check if immediate response is requiredEir/ Building Dept
Building Dept p Licensing Board
intactSelectman's Off/C&
Phone # 0 Health Department
_ . ❑ - Other
r:KMAk'S COMPENSA.TlOr - . .
D, Robert. Niceita,
Buildittr comlinissioner
TOWN OF NORTH ANDOVER
Office of the -Building Department
Community Development and Services
27 Charles Street
North Andover, Massachusetts 01845
DEBRIS DISPOSAL FORM
�4►� ti's\
4@0
oea
Telel)hone (978) 688-9545
FAX (979) 688-9542
In accordance with the provisions of MGL c 40 s 54, and as a condition of
building permit #- the debris resulting from the work shall be
disposed of in a properly licensed solid waste disposal facility as defined by'MGL c
11, s 150a.
The debris will be disposed of at/in: r� �-�• �, S�
ti
343 (X-&enWO0 ( 5t, LJ orre$ftr- Ar -t
(Site location)
Signature of permit applicant Date
Michael McGuire, Local Building Inspector JamesDecola, Electrical Inspector James Diom, GavPlumbing Inspector
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