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HomeMy WebLinkAboutBuilding Permit # 7/10/2015 OORTH 41q. BUILDING PERMIT t-ED 11 , TOWN OF NORTH ANDOVER ®� 5.:;:,. `_ .:b APPLICATION FOR PLAN EXAMINATION '' M Permit No#: w -N z,6 Date Received �.q ADRA reD ' SsgCHus�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER_ Print 100 Year Structure yes+0� bno MAP PARCEL: ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Ef New Building ,2-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alt ration No. of units: El Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other /Gl/,�l f,r,,,r,.,y,✓'.``S;f''��:'f%r��i*��-.��l',rrz,Gt�,,�,F%e. �ru-/S'ole"�„'1�w�„,'�en1�."J%�i�%/,r ����„l,��Jfl1,/�I,/n,, y ' „mr(( 1/FLr/fl/� , erse ar��/1 rAI� �� � � rW7r , : � � DEBE PERFORM � DESCRIPTION OF WORK TO hw_- Identification- PleaseType or Print Clearly OWNER: Name ,. ti- �� �„ ... � Phone. Address: - ✓ � ,r �: � � Contractor Name: 14e,niPei ” Phone Email: Address: . �, �� ? Supervisor's Construction License. Exp, Date: Improvement License: " p � �"� Home Irn ,/ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: Check No.: j Receipt No.: . NOTE: Persons contracting with unregistered contractors do not have a ss to the gu cl 7 7— -- .._.,...-,--... tkORTH Andover Town of _� �� ® 0% i h ver, Mass, lr►� 1� �Q�� OCOCHIC"aw.cx ,_ AORATED P"' BOARD OF HEALTH Pt: �R I T L D Food/Kitchen Septic System ♦ y THIS CERTIFIES THAT .. BUILDING INSPECTOR ............. .. . . . ...... . ............... ... ............ ................ �_®� o� '... .... Foundation has permission to erect .......................... building on ... ........ ... ................. .. ... ........... ® Rough tobe occupied as ....k.... . 1...... ................................. .. .. ...rQrl� ...................:......... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMITEXPIRESIN 6 MONTHELECTRICAL INSPECTOR UNLESCONST S S' Rough S Service ........... ..... ..... ..... ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Requiredto Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. ROME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,J1_-­nr_1WV, 1( nstalled by: THD At-Horne Services, Inc. Branch Name.Boston North&South Date: / / d/b/a d/b/a The Home Depot At-Home Services Branch Number- 31 and 33 908 Boston Turnpike, Unit 1,Shrewsbury, N/LA 01545 Toll Free 877-903-3768 Federal ID tt 75-2698460;ME Lie#C 02439;RI Cont.Lic# 16427 CT Lic#FIIC,0565522;NIA Home linprovenient Contractor Reg.# 126493 F Installation Address: &J— City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: Rome Address: City State Zip (II'different from Installation Address) E-malt Address(to receive project communications and Home Depot updates): El I DO NOT wish to receive any marketing ernails from The Horne Depot Project information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy. 41 and THD At-Horne Services, Inc. ("The Home Depot") agrees to ftirnish, deliver and arrange for the installation ("Installation") of all materials described on the below and on the referenced Spec Shect(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#: Onternal Reference) Products: Spec Sheet(s)#: Project Amount ' E]Roo 110 ❑Sidin'_, 'Windows Li histilation 17 [E:I]G,,t ers­/Covers E]Entry Doors EJ te ❑Roofing E]Siding El Windows E:1 111SUlation $ nGtitters/Covers nEntry Doors E1_ LjRoofin,- LJSiding L_J W111doWS "hismaL1011 $ ElGotters/Covers hEntryjDoors E1___ DRoofin.Ig LJSidin, LJ Windows ❑ Insulation $ E1GU1terS/C0VC1_S [:JEnJry Doors F1_ Nfininiurn 25% Deposit of Contract Amount due upon execution of this contract. J Total Contract Amount $ MainePurchasers may not deposit more than one-third of the Contract Amount. I Customer agrees i I hat, immediately upon completion 4f 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 doe. As applicable, each Customer under this Cont-act agrees to be jointly and Severally obligated and liable hereunder. The Home Depot reserves the right to issue it Change Order or terminate this Contract or any inclividtial Product(s) ilICILICICCI herein, at its discretion. if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to it Structural problem kvith 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 Contract. p4yuj!�� Smnmarp: The payment Stirrimary 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 or the Conti-act at the tirne 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 oil Haat Product is complete. In the event of ternnationof this Contract, CtLstonier agrees to pay The liollic Depot the costs of materials,labor, expeows and services provided by The Home Depot or Authorized Service Provider through the date of termination, phis any (iffier amounts set forth in this Agreement or allowed under appucabie law. THE HOME DEPOTIVIAY WITH11OLD 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 Lill derStil 11(IS that this At rccineril is the entire agreement between Customer and The Home Depot with regard to the Products and Installation Services :rid supersedes all prior diSCUSSiOnS and agreements, either oral or written, relining to said Products and Installation. This Agreement cannot be assigned or amended except by a «l rhn Signed by Customer and The Home Depot. Cnstoincr acknowledges and agrees that CLIS101off haS read, Understands, !011-Intarily aCCCIAS the terms of and has received it copy of this Aorcen-lent. Accepted by.. Submitted by.. ill be containedWork area w `' Pre-Renovation Form Date_ NAT-1G9276 This form is used to document compliance with the requirements of the Federal a� Lead-Based Paint Renovation,Repair,and Painting Program alter April 2010. Job Number(s) customer Address � 12,• 11�ClPry — OCCUPANT CONFIRMATION Dust will be minimized Pamphlet Receipt � I have received a copy of the lead hazard information pamphlet informing me of f the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before work began. r � i :. Home Year Built Enter the year my home was built. ilt is 78,my home ead if my Home Year hetherr LeadSafeuWork PPractirequires ete ces a e necessaryper Tpaint EPA orrStatte regulatirmine ons w ® if my Home Year Built is 1978 or after,Lead-Safe Work Practices are not required. ll be cleaned Work area wi Pr nce4,e4fowner-occupant tner-occupant Signature of Pe Certityi ead.. m let Delivery SEE STATE SPECIFIC FORMS ON REVERSE SIDE . /' � r racan•9�•�a ' Te}eILf1�6 SAVE}or}�lurc }abel.a�" }eld ' t•. �'cm°�y . Wealh�r Sh x'12 t,1lin0 • • •CPpB 050^Double Kung Dp' -HfR� tltod°l Bzag�hermal rim" .. . Alum Glaring 1��r.�'� Zo—c ill Grille TT1 A r SGS ,�• Argon r RMAN�E RP �Sfi co?11'1 ?�1 ►�---- - �� p�RpO so1y0 .�$ . I1A ca 0.3� 1 ixY,nr11. RFORM p,�1��GOs�1cn RctitlV•?' , • Ap D 1�C 10��'�' P � V 1{;Sn1LC:i 1�1tblC}� iGc b� LJ� ,1% dolt f9�ti t°t t d I xFR= �d%c1 U0, a bm t^S ' vl,cui.t Tw) ntj,tll,ni 1 � r�Ot oirsJ'rvdt�to dick ��brt^,tM 1'r' 01^9 �TJt�'AW rv+81 ht ut 10 EvGS Ott ^t+x` .00"rT"^1t �d c li�cn;;t1 YG�y,t�,W wt. Co !Jt 1tJ111 �0 1 S.1'1� vi1 s.Un „r,nlrc• U� wT'11mcv c C..trs l.E• LLµu, �1 �1.E-"• �. ftp to LD k or Gtctt lA�r� u OUt �_ H-L-Si 1tj1Y�1 1 ' 11e1sc��11Y;;o _ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite�o Boston,MA 02114-2017 ww .mass.gov/dia t«'orkers' Compensation Insurance Affidavit:Builders/NCG A��o�Y tricians/plumbers. TO BE FILED WITH THE PE please Print Le ibl A Oicantinforrillation � Name(Business/OrganizatiorJIndividual): Address: I/ Phone#: City/State/Zip: Type of project(required): Are you an employer?Check the appropriate box: 7, []New construction employees(full and/ part"tune in g. Remodeling I,❑I am a employer with__ working for in 2,Q I am a sole proprietor or partnership and have no employees9. []Demolition any capacity.[N°workers'comp.insurance required.] p, ce re aired.]t 10[]Building addition 3.0 I am a homeowner doing all work myself.[No workers'com insuran q contractors to conduct all work on my property. I will 11.0 Electrical repairs or additions 4,❑I am a homeowner and will be hiring enation insurance or are sole ensure that all contractors either have workers'comp 12,Q Plumbing repairs or additions p netors with no employees. 13 oof repairs ees andhaveworkers'comp.insurance? 14 ®other v 5 a generab- l contos have employ hired the sub-contractors listed ur the attached sheet. These sub -contractors of exemption per MGL c. � 6.®we are a corporation and its officers have exercised their righ 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *may applicant that checks box#1 must also fill out the section below showing their workers'compenation policy information. ctors must submit a who submit this affidavit indicating they are doing all work the nam hire outside b cco cto s and state whether eor-1 those entities havew affidavit indicating s t Homeowners w Policy number. tContractos that check this box must a employ ees they y mustr vide their workers'comp.p p cy r P employees. If the sub-contractors have employees, that is providing workers'conepensation insurance for my employees. Below is the oli' ms I am anemployer ��� �� information. �/ l an Name: W Insurance COMP Y ® , Expiration Date: Policy#or Self-ins.Lic.#:_� l}� / City/State/Zip: ? V/1 I�� a showing the policy number a d expiration date).f� G Job Site Address: , compensation policy declaration page( to$1,500.00 / Attach a copy of the workers comp punishable by a fine up to$250.00 a Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation im risonment,as well as civil penalties in the a a to the�fficeoof Investigations ions of thle DIA for insurance and/or one-yearp of this statement may be forty day against the violator.A copy d correct coverage verification. provided above is true an and naltie erjury that the information p ^�^� Ido hereby cern Date: Si a Phone#. kcal, official use only. Do not write in this area,to be completed by city or town off ff PermitlLicense# City or Town: Ins Inspector Issuing Authority(circle one): own Clerk 4.Electrical Inspector 5.Plumbing p 1.Board of Health 2.Building Department 3.City/Town 6.other � Phone#: Contact Person: DATE(MMroDmYY) INSi e AP� 02/251015 CERTIFICATELIABILITY6eJ C ONF ERS C) GHTS E THIS CERTIFICATE IS ISSUED AS A 11 M 11 ATTER OF INFORMATION ONLY A TEND OR ALTER TIRE COVERAGE NG NSURER(S)TAUTHORIIZED CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNOT IVELY AMEND, E endorsed. If SUBROGATION IS WAIVED,subject to BELOW. THIS CERTIFICATE OF INSURANCE E DOE KATE HOLDER UTE A CONTRACT ©ETVIIEEN THE 11. confer rights to the REPRESENTATIVE OR PRODUCER,AND IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poticy(ies)must conditions of the policy,certain policies may require an endorsemont A statement on this certificate does not the terms and C NTACT FAX certificate holder in lieu of such endorsement(s). NAME: AIC No): PHONE PRODUCER MARSH USA,INC. ��.tAAlt NAIL k TWO ALLIANCE CENTER DDRESS: 3560 LENOX ROAD.SUITE 2400 INSURERS AFFORDING COVERAGE. 26387 ATLANTA,GA 30326 INSURER A:Steadfast Insurance Company 16535 Y,rAI516 INSURER 8:Zurich American Insurance CO 23841 1N492-HaO_�o- '_---- INC• INSURENew Hampshire Ins Co 23817 INSURED INSURER C' THE HOME DEPOT, R D•Ilimds National Insurance Company HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD,NW INSURER E: BUILDING C-20 INSURER F: ATLANTA,GA 30339 ATL-D03155301.06 REVISION NUMBER:O COVERAGES CERTIFICATE NUMBER: RIBED HEREIN IS SUBJECT TO ALL THE TERMS, IOD NDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS POLICIES OF INSURANCE LISTED GLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER THIS IS TO CERTIFY THAT THE TERM OR C INDICATED. NOTWITHSIANDING ANY REQUIREMENT, LIMITS DOUCY EFF POLICY EXP 90.000 AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CERTIFICATED MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES MMIODIYYYY MMIDDlYVYY EXCLUSIONS ADDLISU R POLICY NUMB 030112015 030111016 EACH OCCURRENCE �$ 1.000. (NSR TYPE OF INSURANCC• I GLO4867714-05 DAMAGE TO RENTED $ LTR P I Es carr ncn EXCLUDED A GENERAL LIABILITY r 9,[1(10 wo ' i 61ED EXP(Any one person) �$ X COMMERCIAL GENERAL LIABILITY I (LIMITS OF POLICY XS PERSONAL 6 ADV INJURY $ [flOCCUR I .000,000 CLAIMSMAD'c OF SIR:SIM PER OCC ENERAL AGGREGATE $ G 9,000,000 PRODUCTS-COMPIOP AGG S $ EN AGGREGATE LIMIT APPLIES PER'. i COMBINED SINGL LIMIT i'�'� I—�PRO- Loc 10310112015 0310112016 Eaawdom X POLICY I I (BAP 2938863-12 gpplLY INJURY(Per parson) $ g AUTOMOBILE LIABILITY 130DILY INJURY(Per acddent) S X ANY AUTOSELF INSURED AUTO PHY DMG PROPERTY DAMAGES ALL OWNED SCHEDULED per aaadent $ AUTOS ' AUTOS NON•OWNED HIRED AUTOS AUTOSI "- EACH OCCURRENCE .------- AGGREGATE I � UMBRELLA LIAR OCCUR $ EXCESS LIAR CLAIMS-MADE I I 03f0112016 X WC STATU- OTH 0311112015 By Lila 10 000 DED RETENTION$ WC017731493 (AOS) (0310112016 $ O WORKERS COMPENSATION NH.NJ,�) FL-EACH ACCIDENT 1�� AND EMPLOY S,LIABILITY YIN NIA WC017731495(AK,KY, I 03@1 2015 (0310112016 E.L DISEASE-EA EMPLOYE $ 1 C ANY pROPRIETORIPARTNERIEXECUTIVE wC017731494(FL) E L.DISEASE-POLICY LIMIT S OFFICERIMEMBER EXCLUDED? Conitnued on Add�Croltal PagO D (Mandatory in NH) I If yyes,tlescnbo DES6descRIPTunder I - ON OF OPERATIONS below I Ires ace Is required ISchedule.If mo p DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks S' CANCELLATION RE CERTIFICATE HOLDER NOTICE WILL BE DELIVERED IN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BE FO TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, 1600 OSGOOD ST. ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER,MA 01845 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. 0.u� \ L .r Manashi Mukherlee ©1988-2010 ACORDCORPORATION. All rights reserved. r ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Sy'p py g{yy4 gq ' ? ii f A Si ;� _ ( ����1����c �' ' rpt ;{ t� aa r 1: �xt ?� tt 40' w BENJAMIN PARKER H 03865 pladslc�v� s 02111120'1 { b2 rY � p. 4U1 L4b'LtSd t'err71It z5ervices Reg ulation v office of Consumer affairs and Bushes ' ® 10 Park P1aza - Suite 5170 Boston, Massachusetts 02116 r - on Horne Improvem�ent'Contractor,Reglstrati Registration: 126893 Type: Supplement Card Expiration: 6!312016 THD AT HOME SERVICES, INC. - RICHARD TROIA - ........ ND PARKWAY SUITE 300 . . 2690 CUMBERLAND 3033 ATLANTA, 9 -- t)pdate Address and return card.Nark reason for c °L:m u --.: Address (_, Real •.mplo}'r..�„ J SC?,1 C. 2oLA-0=n1 oistration valid for individul use only License or reb l-=—Office orCunsuruer N yrs&SusinessRigulation before the expiration date. if found return o Office of Consumer Affairs and Business Regulation 5 + OR1E IMPROVEMENT COFlTRACtOR Type: 10 Park Plaza-Suite 5170 Supplement Card Roston,MA 02116 5 Registration= -126693 Expiratioru.813t2ot6 THD AT HOME SERVICES.1NC.. THE HOME DEPOT AT j 40N. SERVICES /GV � RICHARD TROIA out signature S ��� 2ggOCUMBERI�NDPARKWAY Not valid�vi A GA 30339 L`ndersccreur} w `