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HomeMy WebLinkAboutSIX REPLACEMENT WINDOWS _ 1 TH BUILDINGPERMIT of t&o D ��• TOWN OF NORTHA V R APPLICATION FOR PLAN EXAMINATION Permit No#:e I µ ° Date Received �SS�9CHUSQ� Date Issued- r. 7 IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER An Print 100 Year Structure yes no MAP Oa3 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE ° Residential Non- Residential ❑ New Building One family ❑Addi ion ❑Two or more family ❑ Industrial ❑A ration No. of units: ❑ Commercial V'kepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 11/e! ! r rnfi/rr/f./ �� � / r , //I.,P 1 n/ / /ai✓! , H 1 f // r Irr rf r ,rn r/'' yJ, AY 1VIh Y(�� � :, /.. l/ / /, ,, 1//6IIP'�1 W(kM.1.//�.IIfN"/ !ll/!.!!�Y/,,,/aJInO�;fr!, r it � %O YV(f,�'i �4/�fr I ✓fpr ...ri�� (ll.?l.,/1I %%i 0/// / !/, �� i��,;. ,, �� rr U,,, e , �� //?/i✓ , , t,i�/�Y�, I /�/';��7, � ��l�,�l,f1,1��, �l I � err�,�r�js�, ,/ . Se,pttc��,o,W I�� „�/ ,��, , �� ,,[a,F�ood �, ��❑rWetlands;, O ,Wa ershed Disfrict 9,// �: ESCJUPTION OF WORK TO PERFORMEM NO 6liacl,2AL dentificatio - �as�eTl peor rint Clearly OWNER: Name 6 V Phone: Address: / �. 4 b d�.- Contractor Name: �� Phone: � � Email: Address: , Supervisor's Construction License: 1 .. Exp. Dater Home Improvement License:_ " Exp. Date: C� 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: $ Po, L FEE: $ Check No.: a Receipt No.: 6) NOTE: Persons contracting with unregistered contractors do not have access to the araa'i d -� t%OF?Ty ---mdover T o' 'wn of O to A ® " . _ 2 6 ® n o - LAKE h ver, ass, 1� COC NICHEW�C« y1^ III A04ATE0 1"P ,�� � MIT U S U E �R AV-4111% BOARD OF HEALTH MIF in Food/Kitchen Septic System THIS CERTIFIES THAT ....... BUILDING INSPECTOR ......... ....... .............. ......... ....... ............ ...... .. .. . ..... .... ........ .... 21 has permission to erect ... buildings on ... ............ Foundation ....................... . . .................... . ................................ Rough to . ... to be 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 EXPIRESIN 6 MO S ELECTRICAL INSPECTOR UNLESS CTI TA S Rough Service ................ ...... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired t® 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. II(It1Ih;IMI`ItOvn,nn�.Nl'('ON'rlt,�("r I'r,l^;A«�a;Ith;AD'rui8 !trunci!Nrinrv:liusltm Nurgt.k Sooll'( Ibdt^! 1 J Sold,I�'uulished 111111 i11adailed lay; 'I'1111 Al I11,lnr Set vices,Inc, livaiwit Nminbvvr dl a'(1d,l,t d/It/n 'fill-Morale!!chill Al 1111111v Servite,a N!!i Iioston'l'nnrp(ke,ihut i,?whnasbuly,111A U1.1 I1 full i 4 t r H 11 401 1168 1-'rdrvn)11)11 1,ti;`6`181611;C.II�,I.Ic 11 l'U.'1141 It 1 Cold,14 1) 16 01 CTI icIt lilt'046S,1);NIA Ilollir fall riul',4n,•o11'r111ntl1lilt Iteg,tl I"`6NIaI In InIh1Un)1 Adih'vts: _60 kly)(k,- Joh "� C)f"�`1^►_�I> aver . MA ,c?/?q' � C'il)' "anal'(• %ill N'orlw 1'hunet Mons i`hmre: yell I'tuuu•t Duna^Addrt^sv, _ _ .. _ .. tlf dillcreui I`rtitll hr^,I,Illnilnn Adthrsvl � � � � �,..._ ... � _�i�•"� �. '.1111111 Address it"lreclva^ploic"I ronuuunit'attirpns and dSlate ome Depot ulyd,uc ); l- p/„ mk a i,.. I DO NOT wfsit to a crave soy ut,ukelin)�ennuis liunl*11 0 1 Ita llo I tepol ✓ e �uoi il'Ili)rAililonm.i�ptantt�l�q�w�lo'()Iql�'�1'Irc111aon^nUcthet1ailmss�lollulnii.lartdrliovalt�lalllu ahnvrinwlIll ialinnaddress,apre"IoIauy, I ! , I I mr lye Itir alae i0sinililt itnn("Insiallalloli")of all malv161% tivswlthrd till Iha" bvlu'(v and till Illy lehtcnccd Spcc ShvvUn), nil ill wiaieh are illvoriroralell inlo this C'unlracl bar this r'(tirrnve,.114111!:tsitil any applicable Slam Supph•ancni 1111d Paymetl Sunml,oy athn0hcti Ile C141 and tiny C'Iuualtc Orders(collectively, C"onira'(1 ! .lob It: w,a n _ n ,a � ttiquhgrq'/C'rrglsul, I;nl),,Ilh,nrs W� Ia)i,,.',h'(t•I(sIH:_„ _ Insgrkuion I I V/ I_%jC unh r./l ucrls I,Il lr11y!tool% L.1. nku ii,ir nsomf t n\49aduew Mhlwnl,uiun .. ...w ..�.,_._,.,..- I �lC1un`'nit q f n Wlndnpts�I IIan1'Ix,,,ls I� _ nituolFlhi t tiidn,' n lnwrtl.uiun I)(iallvI,/'('owl, I..IF1111A'1)(y,I% I'll f1llulnuon2�`r Ik�ixr•ilol'(`uohpr'(t Nnunnldoq uponrarrutlunal'Ihlvconh•oci. f11n1uclruwhuHrxrnlatnddrp,railnruarlimn,mlbirdnffill, •411HliltIAroonul Iutult'mllrticlAr000ttl } ( Uslun)cr al,lccs Ib.al, iluanedLdely ulrn11 rvnnplclioll of the vrink I'oleach I1'tx111vl,C'istnoer Will exectlle 11(,"ul(nJpleliam CarlilicartC ° �+a)1e It1 'Wit Y1'%I�i't1¢itt�l-�ats�R�fined by nn illdividual spar Shoct)and pay ally hallanve'(file. As applicable,eitcl'Customer tt)lrrcr tlitdt'r II)ik t1t)IrtiK^1�1fgrees it')'Giajololly'aild sevvrftliy o1111Wiled imd IInI)le berenmter, Tile l ionic Depot reserves the light l0 issue a Change Order or let Minnie This Cunh'aet or any individual I'r(xIjIvI(x)incha lherein,al its discreltan,ii"flte(!nine 1lcpul tie its umhurimd service provider determines than it cannot perlurn)its obligations line to it slruvnu•ai ed problem wilh thy.home,ellvirolunenlnl beards such Its bold,asitesim or lead paha,other x.al"ely colacerns.pricing crror:v or because work required it)complete the•job weal not inchaled in IIIc Contract. I.a1111VIII Suannarv' The l alymcol Sunuuary I1_j 1. '] included as pal of Ilais C onlraacl, sets 1'01111 the lotol C oniraci amounl and payment's required I'or the deposits and final a ills f.... yW 7 I Y I I pn)ntrnis by product fns alrpiie,ahlv). NO'1'IC.I;'1'0(,1I,S'I'OI%lVlt You Il or Iilervris'011le Con plelfml t erlll'iclelely atetl'orrvach listed)Prvahol)et 11sll lilt-flat(,voll defiutvl by indiliduill SpeclSheetslCbvibre want nition illeme(note; tbal I`roduci Is complete. In the event of IermiaaUon ol,this 11'o111ract.Cost yr agrees to pay The Ilnnu'Depot the cost's or malcrhds,labor,expenses nod sertict;s provided by The Ilonle Depol or AuUun'iicd Ser•lice ill-millu Ihrnoph Ihv dale of IcrulinaUor),pills ally othve anuoll las,vet f'ur111 in lids Agreement or allowed under applicable Inw. TIIP;DOM(:Dli.I`OT MAY WITH IOLD AMOUNTS � OWED TO 'I'lli; IlOhlls (id'o'l' leltom '17IF, I)EI'OSI'I' PAYMENT Olt OTIIIl:It PAYMENTS MADF„ 1vI'I"IIOII"I• I,1(111`I'INC'('III:IIC)MU:DI?I'O"1'S(►'1711^:R Rba111i1►11's 1^"OIt ICIS('OVhatl'OF SUCH,1MC)t1N'I:'i. Acceumancc and Author•iznihol: ('mlollwr agrecs and undcrstamis Ilml this Agm rceenl is IIIc entire agrecmenl howeeu ClIsiumcr ,uol'I lir I longe Depot will)rr}:and Ftp the I rgxhlcis and 111slallaiion servfcvs and super settes:111 prior discussiunls and agrcetncnts,either oral or wrilten,refining to said PoKlucl.eand 11wallnlion.This Alnveulcnl cauulol he assigned of amended except by a wriling signed by Cuslunlva anal'I he I Ionic Depot.Customer ilk kno ledges sad agrees 11 1a1 C'ushpnler Ill's read,understands,volunlarily accepts the W11111-of send has reevived a ropy of Ibis Agreement. Acer v Submit Cus tic ti at aturc 1 __..m.__ .... ...w ! plc Sales(, 's ales(ons „mmiree, -� Dai/e Telephone No [/....' 72 1.. /� fx_ ,__...._ Customer's s Sirnala a hale. Sales Cunsultanl License No. CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY Olt OBLIGATION BY DIt1.IVIIAUNC WRI'1"'CEN NOTICE TO`1'111"s IIOMII DITOT BY MIDNIGHT ON '('Ills 'I'tI11tD BUSINESS DAY AVITAI: SIGNING TIIIS AGREEMENT, TIIE STATE SUPPLEMENT A'1TAClilsl) DERE!('O CONTAINS A FORM TO USE IF ONE IS SPLCDFICA LLY PRENCRIIII:D BY LAW IN C'IISTOMKIVS STATE N011C Ca A1)11ITIONM,111..RMS ANI)CON1)ITIONS AItE STATED ON TIIIC ItICVRItSit SIDE ANI)AItF.PA11T OI^CAIS I'ONTItAC"I' 02.09.16 Whits-Branch Allo Yellow-Customor .. � �• ' � ece►4Ylar.nrcan—rocan.gc.ca • Yrs - ask ;�� Q�dllled Femove {abel.aflcr Cutal Inspection; SAVE Ior tulurc relerence Weather Shield ��' , CPDD 050-A-172 D rafing NFRC fJlodel•B108•Double Hung Pe Alum clad Thermal Frame Int-yF_or" 314 inch Glazing Co 11; ZO—E .022 Low—E Argon Fill Grille in Air Space ENERGY PERFORMAIIE RATINGS �I u—Fr�let So,�.18 0.30 11 .7D Sll-P IhklrilSl ADDIT10hlAl. P:ERFORMANCE�RIA T-ItNlGS Ylilblelrulsmtil2o c 0 0,40 Urtn m►pPllcaLit HFBC Proccdurcc bt erbmunce.HFAC nSng1 t NFRC dueic�o6rreco+K^�nd YrnYlccurtr rtpultCt hit"'a ntng1 et16e prodYet drr+ d�ltrtrJolnq 0"',Ptedtcl�nir9i P 1 10!(e prydocl lar�rr2 cpetltc un. tzcd txl of cccirsuau W cnn9lont tnd urs ' +^1 Produ 1 cnd'dOtt All rc roti ' wf tedocl perbnnsnet lnlorttueun• Cvotvllmm,UU:dnifAUnUnUIeC'lI nlrn.o naulrsm�nls C._c end LE.C.C. 1It InllllnllOVnpP 1NLS.2-57 ' 1Atelt or ezceedt N.E .. .C.. Icocdm t.xsuuuulrx (DP) (PSI -tcss,<no Imc�i.�u�ours:cl . _ � loin c1�►�+a'-oc �=-- uX501 N-LCIS 111tXT2Fol p.t Ynt.9�l.b�J i.Arnuu t.�151V I1C � ',.. olt:� • - • atiotscct�ltittsTo • • The Cotmraonwealth ofMassachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2 017 u - jvww.mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITPi THE PERMITTING AUTHORITY. ADDlicant Information Please Print Le 'blv Name(Business/Organization/Individual): Address: (� City/State/Zip: Phone#: �'PJ a Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. F1 Remodeling any capacity.[No workers'comp,insurance required.] 9. F1 Demolition 3.[]1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 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 netozs with no employees. 12.F�Plumbing repairs or additions S. / I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. R f repairs These sub contractors have employees and have workers'comp.insurance3 6.0 we are a corporation and its officers have exercised their right of exemption per MGL c. 14. they 152,§1(4),and we have no employees.[No workers'comp,insurance required.] 'Nny 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 aril ali employer that is providiiig iporlrers'collipensai on insurance for illy ettiployees. Below is the policy alta job site Insurance Companyhlame: A// �° 1 / Policy#or Self-ins.Lie.#: We- 04101 5:77x2_ Expiration Date: Job Site Address: kki,!�Fzy, (, City/State/Zip: Azpt7� / Attach a copy of the workers compensation policy declaration page(showing the policy number and expo anon date). d 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. X do hereby cel ti I slid Ilaltiec erjury that the inforruadon provided above is true and correct Date: Phone#: Official use only. Do not write ill this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ® DATE(1YYYY)ACCERTIFICATE LIABILITY I 02f251015 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 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). PRODUCER CONTACT HARSH USA,INC. NAME: PHONE TWO ALLIANCE CENTER 3560 LENOX ROAD,SUITE 2400 EMAIL ATLANTA,GA 30326 -- INSURERISI AFFORDING COVERAGE 100492-HomeD-GA'N'-15-16 INSURER A,Steadfast Insurance Company !26387 INSURED INSURER a•Zurich Amer'can Insurance Co v T 116535 THE HOME DEPOT,INC. `"-- -- -- - HOME DEPOT U.S.A.,INC. _INSURER C:New HampsNie Ins Co — _ — 23841 2455 PACES FERRY ROAD,NW INSURER 0:Illinois National 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. NOTWITHSTANDING 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. INSR�PE OF INSURANCE `ADDLISUB� - � POLICY EFF POLICY EXP LTR } POLICY NUMBER MMIDDfYYYY i MId100lYYYY I LIMITS A GENERALLIABILITY 030112015 '030112016 EACH OCCURRENCE {s 9,000,000 _ I ! DAY GE TORE14TED X !CO_!A"1GRCIAL GENERAL LIABILITY j RRIM ISESitlie-(Z-Wfrencei--:s K UWTS OF POLICY XS TED EXP(An e EXCLUDED ',.CLAIMS-MAOI []OCCUR j yonperson)_on .,-on)- 5 1 OF SIR.S1IA PER OCC I- -- 9,000.000R-NlY ----- 9,000'm9,0oo, GENERAL AGGREGATE I S _ LGEN-LAGGREGATE LIVITAPPLIES PER; ( { PRODUCTS-COMPIOPAGO S 9,000,000_-_ X I PRO- -� $ POLICY�IrQT LOC D AUTOMOBILE LIABILITY ' iBAP2938803-12 ;03x0112015 03101/2816 COMBINEDSINGLE SSINGLELIMIT 1000000 I i _1Ea accident) i I- ANY AUTO BODILY INJURY(Per person) S ` - X � _- _ ----- _w__ ALL OWNED 'SCHEDULED !SELF INSURED AUTO PHY DMG !BODILY INJURY(Per accident) 5 ---�AUTOS I AUTOS t NON-OWNED I ( PROPCRTY DAh1AGE 5 ` HIRED AUTOS i J AUTOS (UMBRELLA LIAR _I OCCUR ! I j EACH OCCURRENCE— s — EXCESS LIAB -�CLAIMS-MADEi ' j AGGREGATE ':$ `-1-'--- -+ ------- i DED I RETENTIONS I g C E WORKERS COMPENSATION WC017731493(AOS) 03;0112015 030112016 X VCSTATU- 10TH.i — AND EMPLOYERS'LIABILITY I 103:1)112016 TORY LUAITS! ER C' !ANY PROPRIETORIPARTNERrEXC-CUTIVE Y f N I I I�A�C47773i495(AK,KY,NH,W.VT) i 030172015 ;0310 7 1201 6 E-L.EACH ACCIDENT S 1000'000 1 OFFICERf6!EMBER EXCLUDED? N N f A l D 1 (Mand in NH) iWC017731494(FL) 103,x'112015 103:01!2016 I C(.^DISEASE-EA EMPLOY EJ S� It yyes,descnbe under - _ 1,000,060 DESCRIPTIOtd OF OPERATIONS belo.v i ;1.OI1dnVCd On AdddiOnai PayC j !E L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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 NORTI I ANDOVER,I,',A 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESE14TATlVE of Marsh USA Inc. ManashiMukherjee - I ©1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD / lN8rmt58rvices s 4U1 L4t)''Z00?5 P•'2 TGni 6Z�����i 0)/`�����vJLLfiy�iL'U1 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement-Contractor*Registration Registration: 126893 Type: Supplement Card Expiration: Bt312016 THD AT HOME SERVICES, INC. RICHARD TROIA " --- 2690 CUMBERLAND PARKWAY SUITE 300 . . -- ATLANTA, GA 30339 Update Address and return card.1<4arlc mason for chnngc. scat .-, zaaao m _ Address �J Renewal mplo}t:ar.; rt: art. V Of[ice oCCunsu;acr Arfairs&Bnsincss Rtgulation License or registration valid for individul use only s= ®,? qOn1E IMPROVEMENT CONTRACTOR before the expiration date If found return to: rr a q Office of Consumer A.f7airs and Business Regulation �� - = Rei stra5on: .1265S3 Typo: 10 park Y6nza-Suite5170 Expiration:.&!312016 Supplement Card Boston,MA.02116 THD AT HOME SERVICES,INC. THE HOME DEPOT AT HOME SERVICES RICHARD TROIA 2690 CUMBERLAND PARKWAY S Acfl�l�`A GA 30339 Undcrsccretirp Not validwi out signature i i i i i i 1� parti-nent of !'''.lbfic Sifety Re 315it13L'y3t)3. 1I�C�TlldSts)i speci3lf, r si o rs L r ()6/2&2016