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Home My WebLink AboutBuilding Permit # 5/4/2015 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Y0 Permit No#: 7 Date Received CHUS Date Issued: (557 -Z� IMPORTANT:Applicant must complete all items on this page 1 f�7 F, M I, KIM 0, 112, of 4�1 W, 1111011 1 1111,1111 �1111'11111"',1111, ,l,�7l,�J�'I�lr 7 r,r/�rl l�/i�/��r I�,��//�!/,�e;/�/�� fffff / r. r / . rrr , r , „ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family [I Addition [I Two or more family El Industrial El eration No. of units: 0 Commercial VRepair, replacement El Assessory Bldg El Others: [I Demolition El Other ai/oi RIPTIONOFWORKTOBEPE FO ED:� lVig -,571-2 OWNER: Name: Identification- Please Type or brant Clearly Phone: �9 LOAXCV Address: 2W fi2g&�ZJZ '�Srf IVA Pov ,er��l��i 111 r�� ,J�� ,�, , � r„ � � � :,�,, , .o � ,, , ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$lZOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �V) FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to he ara ty u i hature of,Aqent/Owner Signature of contractor Town of Andover r EVA rik. . *-- h r° ., 1ver, Mass, COC LAKI HIC" WICK O. • OF HEALTH SepticPER IT T 'LD BUILDING INSPECTOR THIS CERTIFIES THAT .................................26&4f�.;J. ................ ....................................... fFoundation Rough i to be occupied.hs provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS Rough UNLESS CONSTRUCTI ggELECTRICAL INSPECTOR Service Final BUILDING INSPECTOR GAS �!+ !` INSPECTOR Occupancy Permit Required to Occupy Bu Rough Final Display Conspicuous Place oPremisesDo o Remove ! f FIRE NoDEPARTMENT inspectedUntil and Approved by " Building Inspector. Street No. Smoke Det. HOME IMPROVEMENT CONTRACT PLEASE READ THIS 64001 Branch Name:Boston North&South Date:+7 A' 1_Zo Sold,Furnished and Installed by: THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury, MA 01545 ------------ ...... Toll Free 877-903-3768 Federal ID#75-26984601 ME Lie#C 02439;RI Cont.Lie# 16427 CT Lie#HIC.0565522;MA Home Improvement Contractor Reg.# 126893 Installation Ar Address: AL r 4 C) City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: 1,J 27- N Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates):_. <-_EA Al �Ic WI DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services, Inc. ("The Home Depot")agrees to fin-nish, deliver and arrange for the installation ("Installation") of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively, "Contract"): Job 4. (Interend Reference) Products: Spec Sheet(s)#: Pr!�icctAmourit EIRoofing 11Siding indows R Insulation— nGutters/Covers [:]Entry Doors n- 01 $ EIRoofing Siding indows Insulation 0 E]Gutters/Covers ElEntry Doors Cl FIRoofing [3-Siding--[]-Windows—T]—Instilaiioll Mutters/Covers nEntry Doorsn $ -DR—o—of—itig—USiding—O—Windows-0 Insulation nGutters/Covers ElEntryDoors F1 $ Minimum 25%Deposit of Contract Amount due upon execution of this contract. Total Contract Amount S Maine Purchasers may not deposit more than one-third of the ContractAmount. 4 Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate, (one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable, each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein, at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns, pricing errors or because work required to complete the job was not included in the Contra The Payment Sumtnary #_.1U - 10 included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets) before work on that Product is complete. In the event of termination of this Contract, Customer agrees to pay The Home Depot the costs of materials, labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The—Home Depot with iregard to the Products and Installation services and supersedes all prior discussions and agreements, either oral or written, relating to said Products and Installation. This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. Sub fi�td by:V • t EWINDOW SPECIFICATION SHEET Spec-Sheet�:� i? � � Sheet: � of r� 'Customer: ___ Jobl .. Consultant �.. Date: New Window j Hinge Locations Labor From outside, ExistingWlnc�ow Measurements Grids,'_ Product Options Options i Leftto Right t says'sows, Location Calor Rough Opening nofbars 8ofbars Esmnts,7P.n6 - useL,R&S Glass MIsC Items- Hardware Code For doors use Screens "5"=stationary or 1 0 N Mull X" operating Style Wraps Code {Y/N) St IeCjjoo�de. Series Code T..rnn. s z Vhf 33 t. w� ` '` T y i _ - ;a t -r8 51 tf "Tpe SPECT LCONSIDERATIONS: IV �'�Bay or Bow window: -Birch or Oak) ` VV OtAl L Bay Projection Angle (31°or A5 z BayFlankerType(DNiSHofCsmnt) if57.5 '"" Top ofwindow to soffit Bn�hes) - �— - "'r If tied to soffit,color of so material I have reviewed and agree with all thejob specifications above and the ConstructR t,col rot so! ' Special Terms and Conditions on the back ofthe yellow(Customers copy, i Garden Window: Seatboard Material:tvinyl only-White Plonite;Birch orOak) _ Customer Signature Wall Thickness,(inches) Additional Shelr(Yes orNo YY 1.76rrcix.nn gm.nle h.now hl4glm will m4rch"lom Calm, White-rho Home Depot Yellow-Customer - trio-,va $xGSVNNG3r-W- EE I The Commonwealth oflMlassachusetts Department oflndustrialAccidents 0 1 Congress Street,Suite 100 Boston,MA 02114-2017 _...__............................._..._..._._.____......._._.....__........._...._------ .___.._._. ._....----......g.._---._.._........._............_.._........._.___.......__..__..._..._._.__...___....___..___.._.____......_..___......_---------._....--------__.._.........._._...._._.__.... . Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name(Business/Organization/Individual): Address: City/State/Zip' n��Phone#: � �� '°•''�' Are you an employer?Check the appropriate box: Type of project(required): IQ I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp,insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions p netors with no employees. 12.F-1Plumbingrepairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.VOther These sub-contractors have employees and have workers'comp.insurance.16QWe are a corporation and its officers have exercised their right of exemption per MGL c. 14. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Insurance t A/W Insurance Company Name: �+ ,r� Mxl--P&�)ae Policy#or Self-ins.Lie.#: wt.- a ® 5� Expiration Date: Job Site Address: (�'" D z V VX City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy Aumgerand expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this stat may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby cern and Hallie erjury that the information provided above is true and correct Signa _- Date: Phone#: 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: .. � ' � D1181q�'IaLnrCtll—rnC3n.gC.CB y pSrc1111rd p P alter Cu�al inspectidn; SAVE for tu•turc relerence . Elemov� lab..l. . Weather Shleld • CPD@ 050�A--172 D NFftC fJlodel 818 Double Hung perating Alum clad Thermal Frame 314.Inch Glazing I F•ry rt,non Law—E Z D—E . . �, Argon Fill Grille in P" Space ENERGY PERFORMANCE RA�c ,GDnat�. SDiat N .30 �-F�tle� 10 ort � • Q rrklt;�si sn—p IONAL p' RFURMANCEpR{ATI1�rGS Ylzlble 1 txnstttk112oct O ' le D.40 brn b WP11cahlr HFHC Prorcdurct br k r9ulreur.r stpultttt htt hes+ntngS em HFM1G "Ing%rn dilermdned br r erlDmwc� q HFfi�dDn 101 resnrr+r' d.undDing vhdc Pr9dtcl aniryr P s�uJdc�rsd�d X!ML rgic us.. UT Product u d'doet nil ve n t b�wlt,biDtr a prDdDc{in e I sP 4z rd cel DI �arlrmrD"W rnnditonf u+d aumri( CvDsutlmrnul+ctunl'IRUnurcbro�wC1wvrut{IlperbnrvnalnbmvnDn. D ulramanls µgals Dr escaed► k1.EC.• C.E.C., and I.E.C.C. Kir Inllltratlon h a Icacdtn JKSVA1.IlA1HYf wt)x IWLS.2—17 (DP) ' .(PSO H—LCJS d< {,yi(ra I.1111.h'rDLL 1lCSl IDM s�uuo_os 111"ni' 191 Islu ISc U.t Y,rlr 9ry cF+rd C.drrnurr�u D,a:n 610�SCD21.11KSTD rn«a7LI,_1— i _ -- —•- Department of Public Si fey N' J�o,nrd of Bijilding Regulations Uld StMlddrdS Comtruction Supvokljl-SP-11111\ License: CSSL-099823 DZMI'rRV BROVIN ----------------------------------................ ------------ 70 NORTON AV Manchester NH 03109' tlO a-- Expiration cornmisstont,r 06/26/2016 Permit Services / 4U1 'L40•Z000 p.G s 41 Office of Consumer Affairs and Business Regulation 10 Park Plaza m Suite 5170 Boston, Massachusetts 02116 Home Improvement"Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2016 THD AT HOME SERVICES, INC. RICHARD TROIA ---- ------- 2690 CUMBERLAND PARKWAY SUITE 300 - ATLANTA, GA 30339 -- _.....__.. ........-.___ Update Address and return card.Roark reason for change. SCAT �s 2014-0-5-M / Address (=J Renewal .,mployr:icr,� J ;.,ostLnru Office of Cuusumer Affairs&Rusiness Regulation License or registration valid for individul use only 1 7177 }. ``t{Ofl1E IMPROVEMENT CONTRACTOR the expiration date- 1f found return to: 1.,t k Office of Consurner Affairs and Business Regulation Registration: .126993 Type: 101 Park Plaza-Suite5170 Expiration:.81312096 . Supplement Caret p Boston,iK A 02%16 THD AT HOME SERVICES,IN(f THE HOME DEPOT AT HOME SERVICES ' RICHARD TRQIA - /Notvalidwi L2690 CUMBERLAND PARKWAY SX'FDA `A,Gla 30339 Underseeretary out signature ACOOREP CERTIFICATE OF LIABILITY IDATEIMWDD NSURANCE 02/24/2015 NYYY) L THIS CERTIFICATE IS ISSUED AS A 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 policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms certificate holder In lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. -NAME: I TWO ALLIANCE CENTER PHONE FAX(A/C.No.Exti: I JAIC.No 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 100492-HomeD-GAW-15-16 INSURER A:Steadfast Insurance Company 26387 INSUREDTHD AT-HOME SERVICES,INC. -INSURER B:Zurich American Insurance Co 16535 DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003242685a 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 CONTRACTOR 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 E OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE INSR-M& POLICY NUMBER (MMIDDIYYYY) (MMIDDNYYY) A GENERAL LIABILITY GL04887714-05 03101/2015 0310112016 EACH OCCURRENCE $ 9,000,000 DAMAGETORENT1,000,000 E5__ COMMERCIAL GENERAL LIABILITY PREMISES Ea $ E.occurrence CLAIMS-MADE I—XI OCCUR LIMITS OF POLICY XS MED EXP(Any one person) S EXCLUDED OF SIR:$1M PER OCC PERSONAL&ADV INJURY S 9,000,000 GENERAL AGGREGATE S 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,000,000 I F_x1P0UCY I JPRO- [7]LOC $ 8 AUTOMOBILE LIABILITY BAP 2938863-12 03/0112015 03101/2016 COMBINED SINGLE UMIT $ 1,000,000 (Ea accident) - ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Par accident) S AUTOS AUTOS NON-OWNED PROPER DAMAGE I $ HIREDAUTOS AUTOS (Parse�dd UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS LLAB CLAIMS-MADE AGGREGATE DED I I RETENTIONS C WORKERS COMPENSATION WC017731493 (ADS) 0310112015 03/0112016 i C EMPLOYERS'LIABILITY YIN WC017731495(AK,KY,NH,NJ,VT) 03/01/2015 03101/2016 0TH- AND 1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N NIA D (Mandatory In NH) WC017731494(FL) 03/0112015 03/0112016 E,L DISEASE-EA EMPLOYEE $ 1,000,000 ]fes 6 Conitnued on Additional Page 1,000,000 DESCRIPTION desc be under OF OPERATIONS below E. DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) EVIDENCE OF INSURANCE J CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PAGES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. I Manashi Mukherjee 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD