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HomeMy WebLinkAboutBuilding Permit # 6/29/2015 t%O BUILDING PERMIT ,,ERDTH'6 TOWN OF NORTH ANDOVER 0 APPLICATION #- FOR PLAN EXAMINATION 0 Permit No#: Date Received ArED C Date Issued:.��,-V( PQ .epi -- IMPORTANT:Applicant must complete all items on this page LOCATION 14-)M�T AID Print PROPERTY OWNER ��� Print 100 Year Structure yes 0 MAP PARCEL: ZONING DISTRICT: Historic District yes no TYPE OF IMPROVEMENT PROPOSED USE Machine Shop Village Aye no Resiodintial Non- Residential 11 New Building One family [] A,4dition 11 Two or more family El Industrial El;Wteration No. of units: 11 Commercial VRepair, replacement El Assessory Bldg El Others: El Demolition El Other Flood DSGRIPTIr> /0�ON 03FWO"TO Be ERFORM P-d) 2z� k) Identitic Plea e TyPe or Print Clearly OWNER: Name: 15e;1'2 Phone: Address: 1> Contractor Name:io M, Phone: LIN Email: Address: Supervisor's Construction License:( Exp. Date: , /V 7 Home Improvement License: Exp. Date: ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ J&O FEE: Check No.: r 1.) l-"" Receipt No.:Aeie'l 1) NOTE: Persons contracting with unregistered contractors do not have acces o t e(I aran .......... ttoRTL- Town of E 1, Andover ® 0 . o ���� h ver, Mass, COCNICHEWICK A04ATE D V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System warm .. .. ,�A. .. VA.ZZ� BUILDING INSPECTOR .... ................................. THIS CERTIFIES THAT .......... ....... .......... Foundation AMRhas permission to erect ..... ................... bui dings n .......... ..... ........re**................. ... .................. �i Rough tobe occupied as ......... ..... ........ .........................`........................................................................ Chimney 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT E IRES 16 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIONYSTITS Rough Service .................... � ................... Final bING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy PuRough Islay in a Conspicuous Place on the Premises — Do Not Remove Final o Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. itONTE INiPROVC•.NiENT CONTRACT PLEASE READ THUS Sold.Furnished and Installed hv: 111-01101 Nanta:It+rsfoo North.@ Saulh L)ute:s-1,301,;aITTE)At-Hunte Scri ire,, Ihr- dAVa The Home Depot At-Flume Sen ices ►tranrh Number:31 and 33 90S Huston Turnpike,Una I.Shretssbur\,NIA 015A; Toll Free 8 -I,-9i>_t-1768 Federal Il)b 7i.]6n\aI(1:NtE Lie d C 0244 RI Com.I_ie=1(-427 oI n C"1p'�l.ic�tk 1�1{1C'.n(i65i_'?;Al.-A Home Imprmcntcnt C,�ntrtdor R�_.=1_1,S03 installation Address; _1�G _�,ree't- 1t1G'3Y1�1-IY4Ytlt/WktdiJL_r City Slate Zip Porchawris)c Rork Phone: Name Phone: Cell Phone: t�16F -139 Ilome Address- ill ddress ill diflctenl from instaihuion Address) City State 't Zip i?-n Address(11)receive project connnunications and Home Depot updates): cv I DO NOT wish to receive any niarkcting emails prom The Hume Depot 1'rolect information: Undersigned("Customer"),the owners of idle property'located at the above inmat kit itin address.agree,to buy. untl'I'LID V-I luuiv Services, hoc (-The Hume Depot")agrees to furnish,deliver and arrange for the ill st:illatioo;"Unstallatio[i'+of :til matellak descrtted un file below and un the rclerenced Spic Sheel(,), all of which are incorporated into this Contract by this relcrencc.along with cloy applicable State Supplement and Payment Summary attached hereto and:my Change Orden(collenlwk. "Contract"1: 0 PrtNiucts: See Sheetls)ft: Project Amount Q / �2+� Siding 1Vhtduws Insulation — (j � S ❑Caner.ct,vers ❑Ewry lloors ❑ 31,10330 Rooting Sitting 1Vuulow•s Insulation c•_ ❑Gotien,/Covers ❑Caary Duos ❑ S Rooting Sidme ❑wmJuws imulatw- ❑0tilwr,/Cover. ❑ $ ❑Falco Dnun i Ruortng Siting \VinJutvs SS htsuintirnt ❑Guucn./Covers ❑Coln Down iinintnm 15%Deposit or('ontrct Amounl due upon cxevotion or this contract. Total Contract Amount $ Nfaille nirchmser,nnty not depusif more than unrthird of tu:Contract Amomil, , C'uslumer agrees th:u, immediately upon completion of the work li-)r each Product, Cusmner will e\ecute a Completion Certificate (one liar each Prcsiuct as defined by an individual Spec Sheol and pay any balance due. As applicable.each Customer under this Contract,grecs to he jointly and severally obligated and liable hereunder. The Hone Depot reserves the right to issue a Change Ordcr Or terminate this Contract or any individual PrkNlo,:l(s)included herein.al its discretion,il'The Hume Depot or its authorized service provider determines that it cannot perfinrnt its obligations clue to a smi:lural problem with file haute,ell virunmenfat hazards such as nluhl,aslkstus Or lead puinf-otter safefv concenos.pricing en-ors or h-:.w,e work required to complete the job was not included fn lite Contract. Payment Summary; The Pavithent Summary N_h0(_X 2 . included as part of this Conu.tct. -ets forth the notal Contract:uuuum and Payments required for the deposits and final paymenls by Pn><lucf las applicable). NOTICE TO CUSTOMER Yoti arc entitled to a cooytletch•rued-ln copy of the Contract al the time you sign. Do not ill n a Completion Crrtitlrate i note: there is ane Completion Certificate for each listed Product as defined by indi0dual Spec Sheets)berore%fork on that Product is complete, in the evenl of termination of this C'onrract,Customer agrees to pac The Hone Depot the costs or materials,labor,e\penses and services prodded by The Home Depot or Authorized Service frmider through life date of termination, plots ani other amounts set forilt in this Agrevnieul or allowed under applicable law. TNG.NOMIDEPOT MAY\\ITHHOLD,\\lot NTS ON\'I{I) 'i' O 111J.' HONIE DEPOT FRON4 THE DEPOSIT PAYNIEN'T OR 0'i-HER PA)NIF.NTS 'MADE, MI-HOLT LIMITING THE HOME DEIIO'I"S Ol'HER REMEDIES FOR RECO\TRY OF SUCH AMOLNI'S. lcceutance and Authorization: Customer agrees and understands that this Agreement is the entire agreement lvmeen Customer and The Hume Drrpuh wdh regard Io the Pnwlucls and installation services and supersedes all prior discussuvts and agreenwmt .etther ural Or wrillrn.ref:ding to said Prcxlucts and installation.This Agement cahoot tv assigned Or amended e\:cpt bt a writmg si_nci bt C'u t4 r cut I'he Home Depot.Cuxlonoer acknuwicdges and agrees that Customer haS m;td.tmderstands, %Olttntaril_t accepts the Ie sol and i received a copy of this Agreement. ,1,e,elt Submitted ,- k — 3Q t -- - ---S — Cumumer's Signature Date Sales Consult:uoCs St_na e L ate Telephone No. Customer's Sigdmure _ Sales Consultant License No. _—.----_-- �— CANCELLATION: CUSTOMER MAY CANCEL THIS U;RE NiENT WITHOUT PENALTY OR OBLIGATION BY DELIVERiNG \►BITTEN NOTICE TO THE IIONIF. DEPOT BY MIDNI(JIT ON THL: THIRD BUSINESS DVV AFTi•.R SIGNING THIS AGREEMENT. THE i S1 ATF: SUPPLEMENT ATTAC LIED HERETO (/DN'PAINS A FORM TO USE IF ONC IS NMI IFI( \i.t.Y PRESCRi1DED BY LAW IN i• '%-l)114:AW01 HONAI.TFRMS AND CONDIT10N'S ARE STATED UN SHF.RV%+RSF SIDE.AND ARE PART OF THIS CON FR WT c l IS While-Branch Flo Yellow-Cuslomer The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,NIA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FMED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): v Address: - i Phone#: Are you an employer?Check the appropriate box; T7. N ject(required): 1.❑I am a employer with employees(full and/or part-time).* construction 2.Q I am a sole proprietor or partnership and have no employees working for me in . deling any capacity.[No workers'comp,insurance required.] 9, ❑Demolition 3.❑[am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑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./Icoc calrepairs or additions p rietors with no employees. 12. ing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13, epairs These sub-contractors have employees and have workers'comp.insurance.-. 14.C]Other 6.❑IN are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 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 jab site information. 4W s V Insurance Company Name: /�/ Policy 0 or Self-ins.Lic.m: � Expiration Date: w� o Job Site Adlress: iiOP City/Stake/Zip: kA Attach a copy of the workers' compensation policy declaration page(showing the policy ntrm er and 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 statement may be forwarded to the Office of Investigations of the DIA for insurance P., coverage verification. I do hereby certify and naltie erjury that the information provided ve is true aand�ct- ✓— Date: Signa f Phone 9: iOfficial use only. Do not write in this area,to be completed by city or town officiaG City or Town: Permit/License# Issuing Authority(circle one): ty P Ins ector 1.Board of Health 2.Building Department 3.Ci /Town Clerk 4.Electrical Inspector S.Plumbing P 6.Other Phone#: Contact Person°: 4- ^ Permit 50rvices / 4U1 'L40 ZbOb P•2 i U AL2 �iUi?'�'��LfYi2�flP�l�, fiL t.Gti;JLIL {� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement'Contractor'Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: Bf3t2016 RICHARD TROIA --- ------ 2690 CUMBERLAND PARKWAY SUITE 300 . -- ATLANTA, GA 30339 _.....__.. .......-.___ Update Address and ,::turn card.TIark.rrason for change. scar G zart tii Address Renewal mploymcr.' J ,ustt:nru o. '.7 a,• niu�ar.nr•rn�����_l�,a1;nr,�n:�:,' - 0fricc or Cunsurner AM-irs Rusin tss Regulstion License or red stration valid for individul use only k OWE IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office otConsumerA,ffairs and Business Regulation Registration: .126393 TYPO: l0 I'arR Naza-SuiteS170 Ex ra8on_.gf3/20i6 Supplement Caryl P+ PPI Boston,M.4 02116 THD AT HOME SERVICES,INC.- THE HOME DEPOT AT HOME SERVICES RICHARD TROIRLA 2690 CUMBERLAND PARKWAYS 4�--�6•��— /tvnlidwi GA 30339 Undersecretary out signature '''E��y �. llllP://G11CG/1SG.GIlu.5t4LG.11lil.lLJ/YGIti1l;GL1UlLLr�LL,;,dy I>:" GllV tu... The Official Website of the Executive Office of Public Safety and Security(EOPSS) Mass.Gov Home state Agencies Licensee Details Demographic Information Full Name: RICKY SOUTHERS Gender: Owner Name: License Address Information ddress: Address 2: City: Salisbury State: NIA ipcode: 01952 Count : United States License i License No: CSSL-105993 License Type: CSSL-RF-Roofing Profession: Building Licenses Date of Last Renewal: Issue Date: Expiration Date: 3/14/2017 License Status: Active Today's Date: 9/15/2014 Secondary License: Doing Business As: Status Change: License Issuance PrereqUisite Licensee: SOUTHERS, RICKY Relationship: Attribute Of License No: CSSL-105993 Discipline No Disci line Information Documentum Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us I of I 9/15/2014 8:57 Ar,/t Permit Services 401 246 2868 P.1 A "R& CERTIFICATE OF LIABILITY INSURANCE CATEJI20 1sN-YYYY' 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(ies)must be endorsed. If SUBROGATION IS WAIVER,subject to tate terms and conditions of the policy,certain policies may require an endorsomont. A statomonl an this certificate doos not confer rights to tho certificate holder in lieu of such endorsoment(s). PRODUCER CONTACT 14k4SR USA.I.W. NAME; 35GENTER fA!°tl�fnq:.__.._`T----- 3560 LcNOX RO OALUA\CECAD,SUITE 2NCOJ E•M AIL ATLANTA,CA 303226 INSURER151 AFFORDING COVERAGE NAIC C� 1004�o-HMRCD CAVe`•10 16 -- - __ INSURER A:S:eat a51In,,mace COtttpary 25387 INSURED THE HOVEDEPOT.:NC. INSURER 8_ZUr�h'Afre6Car Lnsdla RCe DO HOIdEDEPOTU.S.A,Itic. INSURER C; Nea'HaMmUrein$Co ---� - 23E41 _...— - .._._..---- ------ B -- UT PACES FERRY ROAD:N:Y INSURER D:Uncis Navcna!�str__o aCcrrp=_ry ?38?; - Ur�RJG C•20 - --- - - _ ATLANTA.CA 30:39 INSURER E: INSURER F: _.-.-"�--- COVERAGES CERTIFICATE NUMBER. AiL•003155301•I`d REVISION NUMBERA THIS!S TO CERTI7Y THAT THE POLICIES Oc INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOMPATHSTAN DING ANY RECUIREMENT,TERM OR CONDI7!ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESDECT TO INHIC_ THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE -ER!JS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY.HAVE BEEN REDUCED BY PAID CLAIMS. - - ,— WSR "• AOOLjSU`B --"""�-- -----TprJ-LILY EFF rPOLICY EXP'� LTR TYPE OF INSURANCE I POLICY NUMBER MMIDDIYv NMfDO(YYYf LIMITS A GENERAL GLO(88771N•CS w, AcweccuRREncE s GC,COD _ I 01RGi C317112t10 c n X 1 COIAMERMAL GENERAL UASILITY i I I ��MEDFXPIAy OAVAGF. R. E� ---�J•-"- --'- (-"' - ' I .R�NLS;$f�a_cccurence 'S 1,OGD,C/JD CLAMS-.MADE X OCCUR WITS OF POUCY XS r �— — �` eneperstr> EXCLUDED OF S1R:31M-FR OCC �tERSONAL8A0V Ml;URy ,S 5.000,000 r GENERALAGGR£CATF I S 5.000.003 li GEMLAGGREGATEUA!;TAPPJES PER: i -RCDUGTS-C07dPiOP AGO I5 i X POLICY 7'0' i_.- LCC I �� 8 AUTOMOa1LE LIABILITY tBAP 2936.663.12 0301x7315 U.G1rtJ15 COMBINED SINGLE t IAIT ANY AUTO t BUD ILYINJURYwerpsnor.} S _ ALLGWNEo —,SC ! �SELFINSUREDAUTOPHYDMG `1.... .........-- ---. AUTOS +—::AUTNONOS ! ( I I BOG:.Y U:}JRY(PEraxdCrly $ r-•--•{HIREDAUTOS _ AUTOg I PRGP'cRTv QALtAGE - S 1 Ppr a--�en0 5 •UMBRELLA IrAB _ OCCUR 1 I EACH OCCURRENCE S FES EXCESS LIAB�., CLAVAS-ti!ADEj AGGREGATE_._.__•___Ti.�__ 7 - OEQ i nET=NTIONS C WORKERS COMPENSATIONI I 11'0017731493(ADS, 03/0/12015 :G3�J12016 X WC 5"-ATU• !6TH ANV EMPLOYERS•UABILrTY YAJ&Tg•�,_ Fn ANY PROPRIETOiuPARTNERiEXECUTrrE FYJUJIN I iWWC017731495(AK.KY,,�H,NJ.V_) `00112015 ,Oy,101201L EACt1 i�CCIDE't7 6 OFPCERIF/rWDER EXCLUDED' L I N/A I _E ($ D (MlndalorV In NH) I .•sYGi1/731454(FL) t0:101!2015 03-IJI016 _L.,DISEASE•EA EMPLOYEE!5 ,-_-- 100C,000 It yes.Cd5^Y1C taAcf : DeSCRIPTON OF OP5RAr ONS below I iConihied On Ad3i oral Page =,L-OIS'c/vE•POLICY;IIAIT S 1•DOC'• I I j i 1 � ( DESCRIPTION OF OPERAT(OIIS r LOCATIONS I VEHICLES(Allaeh ACORD tot,Addltlonal Romaft Schedule,it more spate is requireal CERTIFICATE HOLDER CANCELLATION 'OWN OF NORTH ANDOVER 16000550'JD SI. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS- AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhorao ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(20fO10S) The ACORD name and logo are registered marks of ACORD