The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 9/30/2015 t%ORTII s " BUILDING PERMIT ,.� h4<:''•_ o TOWN OF NORTHA V ° K APPLICATION FOR PLAN EXAMINATION * - Permit NO: Date Received Ccwu$�4�� Date Issued: 1 IMPORTANT: Applicant must complete all items on thispag e LOC/�TIOR F , 10, Prrn PROI�l=RTS(OWNER s, Pant MA�.NO � PAR�EL ZONIN',G t�I�TRICT�Hrstorr�Dfstrrct yes no Mechine��ht�(�Will�ge ��s rYo , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family El Addition El Two or more family El Industrial ❑ Alt ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �`Septrc ❑Well o Floopla�n ❑C/lletlands Watershed Qistrict 1NaertSr3uver Identification Please Type or Print Clearly) OWNER: Name: Phone Address: PL bb,N' Nama Address OWE upervispr"s Cpnstrucon Ltcrte xp� a er f r! Hosie Im�ro�'emrerf#LFcense ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ Check No.: 2�` I Receipt No.: 2—A 43 NOTE: Persons contracting with unregistered contractors do not have access t t uaro my f nd Sign afu�re`ref,'A -n CQ nev ;� 'Signature of ebr`itra� t%ORTH 01111 I UW11 Anuo V V11 ® to ® ,-17 - n h ver, Mass, OLAKE �• COC NIC N!WICK ADRATE D S V BOARD OF HEALTH ERMI �T T L111111111110 Food/Kitchen Septic System • r� I +� BUILDING INSPECTOR THIS CERTIFIES THAT ...................'................................. ...... .1: ....................................................... has permission to erect ........ Qldings on Foundation ... ..T � ... .!�................. . .. .. .... Rough to be occupied as ................. ...... ...............N...... .................................. 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 I E IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIOS RTS Rough Service .................... ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required 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 Approved by the Building Inspector. Burner Street No. Smoke Det. Sep 15 15 10:34p Rick Odonnell 6033780151 p. 1 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name:Boston North&South Date:�/ / S THD At-Home Services,Inc. d1b/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#75-2698460;ME Lic#C 02439;RI Cont.Lic#16427 c�e� CT Uc##MC.0565522;MAA�Home Improvement Contractor Reg.#126893 Installation Address: 1 l Fred /6 �' s'T�'I`elo-', /�� OiPYs City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: �n-V �CJ [ [97Y] 697-179/ [781]dp7-31,2 Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I 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'I'M 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 Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change (collectively. "Contract"): 0 049, job#: a"t—t Rd—art Products: Sec Sheet(s)#: Project Amount Roofing ElSiding XWindows LJ insulation P 0 [:]Gutters/Covers ❑Entry Doors C1 � S�- �'�17 Roofing ❑Siding Windows Insulation $ 7 ❑Gutters/Covers ❑Entry Doors ❑ _CTRooting OSiding 0 Windows 0 Insulation ❑Gutters/Covers ❑Entry Doors❑ Rooting ElSiding El Windows 0 Insulation $ ❑Gutters/Covers ❑Entry Doors ❑ linimum25%Deposit of Contract Amount due upon execution of this contract Total Contract Amount $ Maine Purchasers may not deposit more than one-third of the Contract Amount. 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 die Contract. Payment Summary: The Payment Summary # /1 V V 8'61 , included as part of this Contract, sets forth the total Contract amount and payments required for tie deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER Yon 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 LINII'I'ING 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 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 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.G� Acce t / � Submitted X usto er's Signature Date Sales Consultant's Signature Date n X Telephone No. Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT'WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY ATTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORAM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERNIS AND CONDITIONS ARE STATED ON THE REVERSESIDE AND ARE PART OF THIS CONTRACT 03-17.15 White-Branch File Yellow-Customer i The Commonwealth of Massac Depanment of Industrial Accidents — ®ice of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/ConYtiir ians/PI><tmbers � — A, � Please P:1nt]Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are an employer?Check the appropriate box: 'Type of project(required): [2, . I am a employer with 4• ❑ I am a general contractor and Iti ❑New construction employees (full and/or part-time). have hired the sub-contractors❑ T am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 1:❑Plumbing repairs or additions myself. [No workers' comp. right of exemption,per MGL ' 12.Q of repairs nsurance requirred t c. 152;§1(4),and we have no .13 employees. o wor ers comp.insurance required.] "Any applicant that checks box#I 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. iContractors that check this box must attached an additional sheet showing the name of the sub-contractor;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 gray employees. below is the policy and job site information. Insurance Company Name: Cp Policy#or Self-ins.Lic.#: Expiration Date: _ Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth of a STOP WORK ORDER and a fine of-up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify an er he ain and pe?natties of perjaary that the information provided abov is trace and correct. Si afore: 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): 1.Board of health 2.Building Department 3.City/Town Clerk 4:Electrical Inspector 5.Plumbing Inspector 6.Other ' Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE 07;'i y2015 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER T iFICATE HOLDER. THIST CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES i 3ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE77NEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the pollCy(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 MARSH USA,INC. nNLW T TWO ALLIANCE CENTER PAX 3560 LENOX ROAD,SUITE 2400 1(AIC No): ATLANTA,GA 30326 S: 100492-HomeD-GAW'-15-16 INSURERS AFFORDING COVERAGE NAIC A INSURED R A.Steadfast Insurance Company 26387 77THD AT-HOME SERVICES.INC- B:Zurich American Insurance Co 16535 DBA THE HOME DEPOT AT-HOME SERVICES 2690 CUMBERLAND PARKWAY,SUITE 300 C NNew Hampshire Ins Co 23841 ATLANTA,GA 30339 D:Illinois National Insurance Company 23817 E: COVERAGESINSURER F: CERTIFICATE NUMBER: ATL-003746646.13 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR DEVISION NAM D ABOVMEBFOR T HE 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 TER:v4R, CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'N'R• EX LAR I TYPE OF INSURANCE AO POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY POLICY NUMBER MMIDD/YYYY IM Do LIMITS T GL04887714.05 03/01/2015 03101/2016 I CLAIMS-MADE �OCCUR EACH OCCURRENCE s _ 9,000,000 DAMA_G_E_TO LIMITS OF POLICY XS PREMISES Ea occcu encs S 1,000,000 OF SIR:$1 M PER OCC MED EXP(Any one person) s EXCLUDED GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY IS 9,000,000 X POLICY I i'— LOC GENERAL AGGREGATE $ 9,000,0(7(1 .OTHER: PRODUCTS-COMP/OP AGG S 9,000,00') B AUTOMOBILE LIABILITY BAP 2936663-12 S X ANY AUTO 03/01/2015 03!01/2016 0-MBIR-ED SINGLE LIMIT $ 1,000,000 ALLOW'NED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS SELF INSURED AUTO PHY DMG - - NON-OWNED I BODILY INJUP.Y("';r aoddenl),S HIRED AUTOS I AUTOS PPe�acErlRdengAMAGE s UMBRELLA UAB S (OCCUR EXCESS LI1AB I CLAIMS-MADE EACH OCCURRENCE g DED I RETENTION S AGGREGATE $ C WORKERS COMPENSATION WCO17731493 A $ C AND EMPLOYERS'LIABILITY ( OS) 03/01/2015 03/01/2016 X PER JER'1 ANY PROpR1ETOR/PARTNER/EXECUTIVE YrN (AK,KY,NH,NJ,VI) 03/01/2015 03!0112016STATUTE D (Mandatory In H)EXCLUDED? a N 1 A E.L.EACH ACCIDENT 1,000,000 (Manddtoryb Nnd W (FL) 03/0112015 03/01/2016,RIPTIOeunder E.LDISEASE-EAEM1,000,000DESCRIPTION OF OPERATIONSbelow Conitnued Additional Page ELDISEASE1,000,O;Yu DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached i1 more space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA,GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. ManashiMukherjee ORD CORPORATION. Al(rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks o AC RD - '—,.-ja.J� , '�-�'•. �y-� ,+ ''i�r�d/3��}yam/• !.i a- rh 1 7;�.i..1 1- -1 t. 1 Y ./ j - ��f-'.f i.`! 1 1 i 1 ti• ?� :�L� - s.. r� r.r 7.i'� �s� yf-b•• �r .� a ...,�_L�_r �. t- p �� ! Aston,W3 s3ont card J . THD A HOWESERVIDES, INP, ATLANTA,NO . . . . •• � a�ddr "��T�.�nAv;�) ��i�D�d�r�i j�,�s?�„a . ' ��>:Z%r.�r�wr.�%rre:r��r�-^:�l�:a�ri�•l.r;�•:I• . �`'♦ .�, �•s � ;ion�a33�Jnr iia��id�i�tas�.or}y `%'�•-•+..IN ,��euT Consc��•'� ��S�aSIa�� i�..,,n3a�o� , �,1�. n��P3,.�si.�p' Q ITat'e the eo-• tt�x� af�. aphJ cna Est— imp d`etis3 f;�.,a�J�fol�S` s�' -tsi [� isirr %�IkIRWDW. 12M' u �ti up�catdoa�ti 11;rD�� ftpplamentCaiti MA Cy—tEWMR, ShIE Ht'Jliilf: f-`C3 XTl""� SEWOES 4 Q GUMSEit MDP P RKWAY S Xu1� `.�.1- -l Q3SL-099823 y BROVEV ` 70 NORTON AVE MsnChester ice$ of 09