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HomeMy WebLinkAboutBuilding Permit # 9/30/2015 ORTH LIED 0 BUILDING PERMIT 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: A i2 IMPORTANT: Applicant must complete all items on this page ON' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential — 11 New Building U ene family 11 Addition 11 Two or more family 11 Industrial 11 Alteration No. of units: 11 Commercial EAepair, replacement 11 Assessory Bldg 11 Others: 11 Demolition 11 Other 61'"ti2,c h A .......... Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: I nr__ V% / / o „� r J ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST EASED ON$125.00 PER S.F. 0 Total Project Cost: $ FEE: LCr6— Check No.: �2'.] Receipt No.: `1L° NOTE: Persons contracting with unregistered contractors do not have acres I th gu ant fund ibnature,"of',�,�gqnu '77,77 r of, t4ORTH ' irum-'k, wn otljtduver 2 „ � e ® - 0 h ver, Mass,& 0 ;)6165 O LANE COC NIC NE w.CN � AoR�1TE0 S U BOARD OF HEALTH Food/Kitchen PERM,IT T Law Septic System �Jp '%% THIS CERTIFIES THAT ® BUILDING INSPECTOR ............................ .......................................... ........ ....................... ............ Ir .... .... ..... has permission to erect .......................... buildings on ..... z....... ... ..... Foundation. ... .. Rough to be occupied as ........100.,. a Chimney provided that the person accepting this ermit 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 PERMIT IES IN OT S ELECTRICAL INSPECTOR UNLESS CTI RTS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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. Sep 10 15 11:49p Rick Odonnell 6033780151 p. l HOME IMPROVEMENT CONTRACT PLEASE READ THIS qq G} Sold,Furnished and Installed by: Branch Name:Boston North lrs South Date:rl(/ 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,MA 01545 Toll Free 877-903.3768 Federal ID#75-2698460;ME Lie It C 02439;RI Cont.Licit 16,427 // / CT Lie#HIC.056555222;MA Home Improvement Contractor Reg.#126893 Installation Address: !Z 2, A,lir" U� J7` v r /(/T 415 `1 City State Zip Purehaser(s): Work Phone: Home Phone: Cell Phone: le; _-72a 1197d 97.E-1811 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 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 Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(colleyyely, "Contract"): G` ; O Job#: (Int—al ita -mom) Products: Sec Sheets)#: Project Amount RoofingSiding Yrndows U Insulation 'W�5_033-9-0 ❑Gutters/Covers ❑Entry Doors ❑ ?7�?OY7 $ F7 7i 1 ❑Roofing Siding Windows Insulation S ��(///ll���' ❑Gutters/Covers ❑Entry Door,,[:] Roofing ElSiding El Windows El Insulation S ❑Gutters/Covers []Entry Doors❑ Roofing Siding 0 Windows ❑Insulation ❑Gutters/Covers ❑Entry Doors ❑ S Minimum 25%Deposit of Contract Amount due upon execution of this contract. Total Contract Amount $ ? 9 Maine Purchasers may not deposit more than one-third ofthe Contract Amount. Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate (one for cath Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contruct 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 Summarv: The Payment Summary 4-11 6ul 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 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. Lt 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 LIMITING THE HOME DEPOT'S OTHER RUNIC,DIES 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. Accepted by: Submitted by: Customer's Signature Date Sates Consultant's Signature Date X Telephone No. 6C 3 " Y7157- Y6s r Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as applicable) AGREEII4ENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE UP ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 03-17-15 White—Branch File Yellow—Customer The Commonwealth gf'Massac�adse s _ _ 1Depariment of Industrial Accidents Oce of Investigations 1 Congress Street, Suite 100 o Boston,Mil 02114-2017 www.mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers I �Aa..Ao.�4an$cnsaaeera4aaaee Please Print Legibly Name (Businesslorganization/Individual): Address: City/State/Zip: ALG1 Phone#: A re an employer?Check the appropriate box: Type of project(required): I. I am a employer with_422 4. ❑ I am a general contractor and I G []New construction employees (frill and/or part-time). have hired the sub-contractors ❑ I 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. n We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption.per MGL ' 12.[, of repairs t�ranse r�quir�ti]t c. 152;§1(4),and we have no 13 01 Other emp oyees. o wor ers 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-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 my employees. Below is the policy and job site information. �---- Insurance Company Name: Policy#or Self-ins.Lic.#: .T�17 �j Expiratidn Date: Job Site Address �'. fp 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 form 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 insurance coverage verification. I do hereby certify and r t P qnsad pe aalties of perjury tbal the infornaa#on pr®vided abav is trace and carred - Si ature: Date: Phone#: a Official arse only. Do not write in ibis area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ' Contact Person: Phone#: CERTIFICATE � �3�°y ] �a`ice �1 1 I`�'�,1 � 1 _ - ._.. / CER }IFIC 3 l E 4E1�" L1 SIL1 1 ! INSURANCE 0711 N2015 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER T iFiCA'TE !OLDER THISA A BELOW. DOES NOT AFFIRMATIVELY OR A1cGATlVELY AMEMD, EXTEA}D OR ALTER THE COVERAGE gFFORDED 13'( THE POLICIES 3ELOt1V. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT SE"ilUEEN TFiE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION_18—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 or such--a-Y, PRODUCER MARSH USA,INC. contracT TWO ALLIANCE CENTER NAME: 3560 LENOX ROAD,SUITE 2400 PHONE No 1 FAX( ATLANTA,GA 30326 i�MA1L AIC No: ADDRESS: 1WA92-HomeD-GAWK-15-16 INSURERS AFFORDING COVERAGE NAIC 4 INSURED INSURER A:Steadfast insurance Company 26387 THD AT-HOME SERVICES,INC. INSURER B:Zurich American Insurance Co DBA THE HOME DEPOT AT-HOME SERVICES 16535 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER C:New Hampshire Ins Co 23841 ATLANTA,GA 30339 INSURER D:Illinois National Insurance Company 23817 INSURER E COVERAGES CERTIFICATE NUMBER.- ATLINSURER-OD3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEENISSUEDTHE INSURED EVIISI D NUMBEORT 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 TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRI AD UB LTR TYPE OF INSURANCE POLICY EFF POLICY EXP A ! X COMMERCIAL GENERAL LIABILITY POLICY NUNIBER MM/DOn YYY MM/0D GL0488T714.05 LIMITS f 03/01/2015 03/01/2016 EACH OCCURRENCE 5 9,000,000 CLAIMS-MADE �OCCUR DANA E TO RENTED LIMITS OF POUCY XS PREMISES Ea omirrencel S 1,000,000 OF SIR:$1 M PER OCC MED EXP(Any one person) s EXCLUDED ( GENT AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY S 9,000,000 I {POLICY! 1 PRO- JECT 0 LOC GENERAL AGGREGATE S 9,000,000 I OTHER: PRODUCTS-COMPIOPAGG S 9,000,00) H AUTOMOBILE LIABILITY BAP 2938863-12S X� 03/01/2015 03/01/2016 COMBINED LI SINGLE MIT ANY AUTO lEa accident)S 1,000,000 ALL OWNED SCHEDULED BODILY INJURY(Per person) 5 auros AUTOS SELF INSURED AUTO PHY DMG � INJURY- - _- HIREDAUTOS NOM-OWNED BODILY Iraxiden0,S AUTOS PROPERTY pAMAGE Pe acddent s UMBRELLA UAB I OCCUR S EXCESS UAB CLAIMS-MADE EACH OCCURRENCE S DED RETENTION 5 I AGGREGATE S C WORKERS COMPENSATION WC017731493 5 C AND EMPLOYERS'UABIUIY (AOS) 03/01/2015 03/0112016 X PER OTH- ANY PROPRIE70R/PARTNDED" CUTIVE YIN N WC017I31495(AK,KY,NH,NJ, 03/01/2015 03/01/2016 STATUTE ER D OFF'CER/MErdBER EXCLUDEp? F N I A (Myyandatory In NH) WC017731434(FL) 03101!2015 03!01/2016 E.L.EACH ACCIDENT S 1,000000 sciiba under DESCRIPT ON OF OPERATIONS below Conitnued on Additional Page E_L DISEASE-EA EMPLOYE 5 1,000000 E.L DISEASE-POLICY LIMIT S 1,OGC,OJ1`. DESCRIPTION OF OPERATIONS I LOCATIONS'VEHICLES (ACORD 101,Addluo EVIDENCE OF INSURANCE nal Remarks Schedule,may be attached it more space is required) t• 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 REPRESENTATlVE of Marsh USA Inc. ManashiMukhejee -u. ORD CORPO ACORD 25(2014/01) The ACORD name and logo are registered marks o ION. All rights reserved. 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