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HomeMy WebLinkAboutBuilding Permit # 7/10/2015 BUILDING NonrH PERMIT of tt4Eo H TOWN OF NTANDOVER O� 9�,'' 'F •6 OM APPLICATION FOR PLAN EXAMINATION ~ -4 . A Permit No##. � � Date Received ��sSAC HUs���y Date Issued: IMPORTANT°Applicant must complete all items on this page 2, n r rir,/, / ,/ r r / ✓r ! / r r ,, / r ✓ / o / r, r r rr r r, r� //, r /PROPE , /YiOWNE ,�i%/>%/// ,�„r„�, ,rr,� /, /./, , �r„ ., ✓,�r,,,,r,, ., ,,; ,,,�,�/,���/,/,�,,�/�ii� � / / , r a r r i ✓ s ,,,,./�� r ,.�..��✓/!rr/�r r'�� � „,��r��///,../�or,//l,/i / / ,,, iof ,o/ roi.ci d,. Jri ri/,1., /r/ / //.. r r i///,.. /r�Ur l>% r„��J / i r/,., ri .,,�///.✓� /..,,,.,,////,rri%/, ////i,/f„////////// rr r rri / r r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential EI-New Building ai7e family ❑Addition ❑ Two or more family ❑ Industrial ❑A ration No, of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other rS/eptic ,Well r, i,///r „ ❑ Floodplain ❑Wetlands ❑ Watershed District i,i,,,rl!✓ ,�„l/r�%iii, /,,,,/il//���,;;,,, ri,,,,,;, ,,,,,, ,., „i,, ,i„r' ,i� �,.,rr / ,ii of///,/,i/r, D RIPT NOF WORK TO PERFORMED: _ , W f w Identification- Please Type or Print Clearly OWNER: Name: µr' Phone: Address: � r,r / ,Contractor/Name r r/ � r ne /r r / i” .// / /i �r✓, :r” r/„ ,r rr rs/„ „,,. ,,.,�/ rr.. ,/r fir, / �...,,. r:,,; r ,,,,,, r�/�//c�/%�/�/i (a� � � ,; / ri� ri, rr.Oi., �%I /. //i//�/// ./ � rr � r r/. r ,„ ,;. //v r✓, � ,��//,� / ,/ �J r r ��dr�S,.S ..�%//�aii,,;,,rr;����i ,.,.//� ,,,,✓/.eP/oi /%„,,;: ,,,,/r„ r„r,/li,r,,..,,, ri, i,,,ci� r/„avic.,,////i/�/�///r,a(¢�/i��,/////r, �,///�,,,�/ % ,/.,,,i rr,rri //„ / / it r. r, /io /f /, // ✓ , „ 1, r / / , � / , a„ /, /.� ✓.. ,�. r. it ,. ,r.. ��. /�� % //i.., r /rrr. //� r,r/ ,fir/l cf,t,: ///,/�. ✓ ., r,a.. /:. ..✓ i ,,.. r � /�:. „, ,,,,, - � i I iy u NW u / / ,✓// r/ � / // / /ii rc r /, r / it r/ / r , /�ome Im rovementa��cense ,�,,,,✓da2arriir Par/d/pti�ra;,,i,,,, a//„ , o,,,,v,,,r� ,,,,,, P ,ies. „,✓/r,,,/O� ,w, „r/;,.,'; ARCHITECT/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: $ ( FEE: $ �. Check No.: Receipt No.: M NOTE: Persons contracting with unregistered contractors do not ha e ac es the guar Signature of Agent/Owner Signature of contractor FORTH Town of Andover O _ �` 0% A.- I ® ® - ".memo- C'O LA.ca � � 'fiery Mass, tox 2.415 cocHICHf WICK �oRRTE® P'pf`���3 ee v BOARD OF HEALTH PEK T T %j LD Food/Kitchen Septic System THIS CERTIFIES THAT v)t e �'�� BUILDING INSPECTOR ............ .................t...... ................ .... ........... .. .................. has permission to erect ... g � �.� Met Foundation ...... ®.......... b ildin s on ... ....... . ......... . .... ................................ .......................... Rough Ato be occupied as ...... /. ..... ........ �.Q .. .... ... . chimney CL provided that the person accepting this permit shall in every respe t 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 EXPIRES I �+ TLLO ELECTRICAL INSPECTOR UNLESS S T Rough Service ......... its BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to ccupy 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name:Boston North&South Date.qjb_12,__) _ 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,TVIA 01545 Toll Free 877-903-3768 Federal ID#75-2698460;ME Lic 9 C 02439;RI Cont.LicY I(A27 CT Lic 9 HIC.0565522;MA Home Improvement Contractor Reg.4 126893 Installation Address: 4 Lv�- city State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: Home Address: AA"Ov- T-1 (If different from Installation Address) ,--C ity State Zip E-mail Address(to receive Project communications and Home Depot updates): Y-N 9-1 DO NOT wish to receive any marketing emails from The Home Depot _���, _Z, ,�Ifrl 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 furnish,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 Conti-act by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job H, tt,r__) Products: Spec Sheet(s)9: Proiect Amount _ Roofing Siding \Vindowso insidati-0-11 S1 )Gutters/Covers El $ Entry Doors n LjRoofing USiding U Windows Insulation FIGutlers/Covers E]Entry Doors EI_ $ Roofing L-ISiding " Windows U Insulation EIGutters/Covers DEntry Doors n_ Roofing Siding Li Windows LJ Insulation FIGutters/Covers REnlry Doors ❑ $ Minimum 25%Deposit of Contract Amount due upon execution of this contract. Maine Purchasers may not deposit more than one-third of the Contract Amount. Total Contract Amount S 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 Contract, Payment Summary: The Payment Summary 41 ' 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 n 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 Tile Home Depot the costs of materials, labor,expenses and services provided by The Rome 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 qfh and The Home Depot with regard 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'File Home Depot. Customer acknowledges and agrees that Customer has read, understands,voluntarily accepts the terms.of and has received a copy of this Agreement. A,C�ptd Sttj���Wdv �_ Jobdk_ Consultant WINDOW SPECIFICATION SHEET Spec.Sheet O Sheet .T_Of Customer;_... ...._414} _r_u_ _! ! � ul.ant..__�r.-:7----' -k �— 41) >;–i.--Y—._.� New Window Existing Window Measurements Grids ProductOptlons tabor Hinge LocationsFrom outside, Options. Left toRight _T Oays,Bows, Location color Bough Opening 8ofbars ilofbars Csmnts,1Pnl, Use L,Rbr 5 Glass Mist:Items Harderare Code Fordoors'use LL 0 Screens "5"=stationaryot .Style Wraps ` v c Y ._ ,y� Mail "X"=operating Aoom Floor Code (Y/N). St le Code Series Code = s > 2 3 1 I I A I 7 it 1 K to i 1 13 i IIII SPECIAL CW SIDERATIONS: Vlrap color Interior Casing Type Bay or Bow window: -Seatboard Materlat:(vinyl onlyafrch or Oak) T Bay Projection Angle qay Flanker Type(DH,5H or Cmnr) - Topof Wndo9 to solUr(Inches) (flied to Writ,color of soft material �� IhaJ moiety dead attreewlth ail the jol eufications above and the Construct Aunf(Yes of No) ` Sped+fierm5an Canditionso a citoTtheyLIlovr(CUstamer)itoPY, Garden.Window; �r Saatb4ard hfaterial:(vinyl only-whi[o pi°nite,ao-thw oaaa Vlall Thld:nes deciles} Customer 5igbatute Additional Shelf ryes or No) 1_7. L1hme n novuuencoct�+a�o.v eaingly>wnpmtthc,nreq cdcr. arc+:s�vo-v-tv Willie-The Hcmn Depot yollaw•Cnctomol TNDIGa. The Commonwealth of Massachusetts Department of Industrial Accidents V­ Workers' I Congress Street,Suite 100 Boston,MA 02114-2017 wwwmass.gov/dia Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information I Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: ' n� Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. El New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Building addition 4.0 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 11.0 Electrical repairs or additions p rietors with no employees. 12,[:]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Ropf repairs These sub-contractors have employees and have workers'comp.insurance.1 6.®We are a corporation and its officers have exercised their right of exemption per MGL c. 14. ther / 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. tContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information, /L%w ��)aew 7 , Insurance Company Name: '' / / Policy#or Self-ins.Lie.#: 6- ® D 0 Expiration Date: Job Site Address.--.1 l A �'J/ ��/��� �� � City/State/Zip: � Attach a copy of the workers' compensation policy declaration page(showing the policy umber 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 coverage verification. I do hereby cern m:d naltie erjury that the information provided above is true and correct Si a Date: � Phone#: 4 } Official use only. Do not write in this area,to be completed by city or town official. i City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 'i ATE AC®R®® CERTIFICATE LSI ILIYINSURANCE o02t26R015omYY1 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((es)must be endorsed. If SUBROGATION IS WAIVED,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). CONT NTACT PRODUCER NAME: MARSH USA,INC. PHONE FAX TWOALUANCECENTER (AIC Not 3560 LENOX ROAD,SUITE 2400 MAIL ADDRESS: ATLANTA,GA 30326 INSURER(S)AFFORDING COVERAGE. NAIC k 100492•HomeD-GAW-15-16 INSURER A:Steadfast Insurance Company 126387 INSURED INSURER B,Zurich American Insurance Co 16535 THE HOME DEPOT,INC. New Hampshire Ins Co 23841 HOME DEPOT U.S,A.,INC. INSURER c: p 2455 PACES FERRY ROAD,NW INSURER 0:Illinois Nalionai Insurance Company 23817 BUILDING C-20 ATLANTA,GA 30339 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-003155301.06 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSlA?!DING 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. LTR TYPE OF INSURANCEADDL SURR POUCY EFF POLICY EXP LIMITS I POLICY NUMBER MMIDDIYYYY MMIDDIYYYY 9 A GENERAL LIABILITY I iGL04987714-05 0310112015 0310112016 EACH OCCURRENCE S -DAMAGE TO 1,000,OOg X COMMERCIAL GENERAL LIABILITY P Ea occurrence 5 CLAIMS-MADEO OCCUR LIMITS OF POLICY XS MED EXP(Any one person S EXCLUDED OF SIR:SIM PER OCC PERSONAL d ADV INJURY S 9,000,000 GENERAL AGGREGATE 5 9,000,000 GEN'LAGGREGATE LIMITAP(P�LI�ES S PER. PRODUCTS-COMPIOP AGG S 9,000,000 JE" X POLICY 7 PRO- i I LOC � f B AUTOMOBILE LIABILITY BAP 2938863-12 10310112015 03/0112116 COMBINED SINGLE LIMIT 1 000,000 X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per acddent) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE S HIREDAUTOS AUTOS (Per acadant) � I S UMBRELLA LIAB OCCUR ' EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE I AGGREGATE 5 _ OED RETENTIONS S C =EERSCOMPENSAnON WC017731493(AOS) 03N112015 03101!2016 X WC$�T U• OTH- C AND EMPLOYERS'LIABILITY YIN WC017731495 AK,KY,NH,NJ,VT 03/0112015 0310112016 1,000,0 ANY PROPRIETORIPARTNEWEXECUTIVE ( ) EL.EACH ACCIDENT S D OFFICERIMEMBER EXCLUDED? a NIA WC017731494 FL 03101!2015 03/01/2016 1•0w,000 (Mandatory in NH) ( ) E,L DISEASE•EA EMPLOYE S It yes,describe under Conlinued on Additional Page E.L.DISEASE•POLICY LIMIT I S 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD tet,Additional Remarks Schedule,if more space Is required) Y CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16000SGOODST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE °" of Marsh USA Inc. Manashi Mukherjee I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Mass-chuaetts -Department of Public Safety Board of Building Regulations and Standards Construction SUPL11-sorSpec"WO. License: CSSL4MV099 172 Vn ALERSS I +T Salem MA 01976-- Expirzition tori mill toner F-ermrt JBrvices / 4U1 L40'L?5bt5 p.'L U 7G2i �G(a) �'n' 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: 8/3/2016 RICHARD TROIA --------- 2690 CUMBERLAND PARKWAY SUITE 300 --- ATLANTA, GA 30339 __ _.....__.. ........-.___ Update Address and return card. Roark mason for change. scar , zoom - Address Renewal ;nploys:cc„ J :<rst ar c Office of Consumer Affairs&Business Rtgulation License or registration valid for individul use only ter` before the expiration date- Cf found return to: 5r•- ' OM1§E IMPROVEMENT CONTRACTOR P Office of Consumer Affairs and Business Regulation Registration: .126893 Type: 10 park Plaza-Suite5170 "ratior>_.813/2016 . Supplement Card{ PPI Boston,MA 02E16 THD AT HOME SERVICES.INC. THE HOME DEPOT AT HOME SERVICES RICHARDA 2690 CUMBERLAND PARKWAYS A t ,GA 30339 Undersccreury Not valid wi out signature I i L i i