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HomeMy WebLinkAboutBuilding Permit # 11/18/2015 FORTH BUILDING PERMIT I E-D---11,6"6 TOWN OF NORTH ANDOVER ® , APPLICATION FOR PLAN EXAMINATION Date Received `�A-rED Permit No#: C Date Issued: 1 �4->Pol all items on this page MPORTANT:Applicant must complete LOCATION ' 114 Print PROPERTY OWNER— Print ioo Year Structure yes no RICT: Historic District yes no 0 PARCEL ` no L b yes MAP - I—ZONING DIST Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential i g [I Oralamily Ei New Building Eoi Industrial lt� 0 v� 1 0-1116 or more family F0 Addition No. of units: EiCommercial 0 A�e<tion El Others: Kf�epair, replacement 0 Assessory Bldg El Demolition Ei Other J sh"b'dj tr '❑ Flood -1— r. DESCRIPTION (� RK TO ERF® M Ide tif, a ion leaAse' ype or print Clearly Phone: OWNER: Name: Address: Contractor Name:- — Phone: Email: Address: Supervisor's Construction License: e Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Reg. No. Address: COST BASED ON$125-00 PER S.F. FEE SCHEDULE.,BULDING PERMIT.'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED FEE: $ Total Project Cost: Rec Ipt, No.: Gam' I Check No.: NOTE: Persoras with ontractingowegistered contractors R e c to the guaranty fund i"r NORT#i Town of2 S WYA'. dover O b O LAKE h ver, Mass, CoCKICKl WICK A94ATED ''P�,��� S V BOARD OF HEALTH PER T L 11111111111111V� Food/Kitchen Septic System . rkewsh THIS CERTIFIES THAT .................. BUILDING INSPECTOR .............. ... . . ........................ . ..... . .. ......... .. ........ .... ....... has permission to erect ........ g Foundation ........ ...... buildings .... ... .�....... ]�L.�. ..... .... ... .13 Rough 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 EXPIRES I 6 NiT ELECTRICAL INSPECTOR LESS TR CTI® TRough low Service ................... . ............... ................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay 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. HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name:Boston North&South Uatc:17_ /1� THD AI-Home Services,Inc. d/b/a The Home Depot At-Horne Services Branch Number:31 and 33 908 Boston Turnpike,Unit I,Shrewsbury,MA 01545 Tull Free 877-903-3768 Federal ID#75-2698460;ME Lic a C 02439;RI Coni.Lich 10427 Lic#HIC'.0565522;MA Home Improvement Contractor Reg.#126893 Installation Address: !1'tN 9]y /�1 P t/�.� /+ 0 1 g t f City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: [ ] [97,8 1873- 7 [ [ 1 [ l [ 1 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 Protect 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(collectively. "Contract"): Job#: two a na--i Products: Sec Sheet(s)#: Project Amount f y Roofing F Siding U Windows U Insulation $ Q T1 S b ❑Gutters/Covers❑Entry Doors ❑ �1 W718 WO Roofing USiding Windows Insulation ❑Gutters/Co%vrs❑Entry lktors ❑ Rooting USiding U Windows LJ Insulation ❑Gutters/Covers []Entry Doors❑ $ RoofingSiding El Windows Insulation ❑Gutters/Covers ❑Entry Doors ❑ $ Minimum 25%Depositor Contract Amount due upon execution or Oils contract. Total Contract Amount $ IF),10 0 Maine Purchasers may nal deposit more than one4hird of the Contract Amount Customer agrees that,immediately upon completion of the work for each Product.Customer will execute a Completion Certificate (one lir 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,it floe 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 Contracts. Payment Summary: The Payment Summary# 1 144-7 ,B included as part of this Contract,sets forth the total Conaaci 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. In file event of termination or 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 AMOUN'CS OWED TO THE HOI(41i DEPOT FROM THE DRPORI1' PAIWIVN'I. OR OTHER PAYMENTS MADE. W17•IfOI)i' I,I htPCING"rlit•:HOhtl•:UGPO'1"ti O'l'tlt•;It RlihtliUtli3 IY>H ItliCOVIsItV OF SUCH AMOUN7:S. '.. Accentance anti Authorization: C'uslontcr agroe,and underaandc tial this Agreement is the entire agreement Ixnveen custonler and The Home Depot with regard to the Pr.xlucts and Instalhuion services and supersedes all prior discussions and,1glteotcoils.either '... prat or written,relating to said Pnxlucts and Insudlation. Ibis Agreement cannot be assigned or amended eseept by a writing sigueal by Cumouter:mol The 1 tome Despot.Customer acknowledges and agrees that Customer has read,underslands.voluntarily'accepts the teens of and has reel overt a copy of this Agreement. C otloopvderified Submitted by. 0111-5 1130AM EDT MK2-PO55-XLQf-UBLP X onier's Signature Datc Stiles C:onsulta it's Sign.lure D'he X Telephone No.__ 972-7771-3b-73 Customer's Signature Date Sales Consultant License No. _ CANCELLATION: CUSTOMER MAY CANCEL THIS la,appltcabtet AGREEMENT 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 IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TF,RAIS AND CONDITIONS ARE STATED ON THE REPF.RSE SIDE AND ARE PART OF THIS C'ON'TRACT '.. 02-83-15 While-Branch File Yellow-Customer Scanned-by CamScanner i 3 3 III 3 dotloop vedfied DG95-EN5 ll:30AM EDT LV.��.X.�7.�.�t'Yr• DG9ENQV-YWX-CZK4 Scanned by CarnScanner VINYL WINDOW PRICING WO HEETBOSTON f cowww, .; Job t q d��1aL�! WINDOWS q GRIDS TOTAL F xZ "4" sK4 s WIr►�3vw SIM Price/ Window 00*41 osoph r Orid + W09 C4A*( UI Window Price sato w*ws Ptics Qrids ..m (A) TOTAL.WINDOW PRICE (BEFORE OPTIONS): (004$ t��li1144 1 Scanned by CamScanner I VINYL WINDOW PRICING WORKSHEET BOSTON American Craftsman WNNW 4 KAH P17 Unit Meas. Qty. Unit Pike Sub-Taal (W x H)1141=Sq.FIL Sr(Ft $14 Ia41118010011 _ Double Hun Screen $17 1 deduct for Fix Ad f l ?tat Leh ... � tced Soeh� Casements Par seen $183 millorill Choc o for DPD etc. Mu11on $83 WINDOW HARDWARE OPrrONS Kipeng Hina Casements window $19 PRS 5100 NDOW&GLASS OPTIONS Unit Mea,. Qty, Unit Price sub-Total Sgyta�T _ase w.......... .. ._.. _ ..._-- (W x H)1144.8q.Ft. �Ft 1 01191 ura rhos $8 I1ull8eroen _ DH and 2 PNL 811der screen $18 Aclrl I Otter bosh/deduct for Fitted Bash � Casements Per seep $89 Muilin Choi a for DPD etc. Mulilan $59 PAM DOOR OP77ONS Polished pines Interior Handle Par Door $83 C PRS6100 and AC 12 OPTIONS SUBTOTAL: .1. "2" 1x2 LABOR OPTIONS Unit Meas. coy. Unit Price sub Taal Land Sato Renovation 4 Wndows Per Opening $35 Motal Window Raltiaa9rttanl(exoi Nay now Ciardan VNndmw d Pelb ar tlsrden Daorr Per Wr4ow $109 Additional Char s lot Stool Pan ftotrtaval Each $199 Canetruct Hoof over Ba ly paw VMndow Each $657 Door Up to 120 UI Each $80 121-180 UI Each $95 (or Deduotion for No Wrap) Over 180 UI Each $120 Custom Calor WindowlDoot Wrug„_,, ____ (only H<8 windows Per Job $78 Naw httodar Wtrad Coale nO Par un.Ft. $10 Q Roalova&Rri1matall AIC Unit Each $58 Remove&Reinstall Awnings Up to 8' Each $35 _ Over 8' Each Bid Remove A Reinstall Shutters Pair $23Lin Simonton Nail Fin Up to 120 UI Each Bid p Over 121 UI Each Bid prrstan City f;irnl . Por.ab $187 M Misc.Labor Call for Estimate of Hours Per Hour t $55 5� Q D LABOR OPTIONS SUBTOTAL: 5 TOTAL PROJECT AMOUNT A + B + C + D): IP 10-3 ESTIMATED MONTHLY PAYMENT *: `E ual to Project Amount T0111111 based on the assumption of 84 months and 13,99%APR Scanned by CamScanner The Commonwealth of Massachusetts H Department of IndustrialAccidents y , d I Congress Stt-eet, Suite 100 Boston,NIA. 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILER WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leibl Name (Business/Organization/Individual): v Address: City/State/Zip: one 4: '1� � = 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. n New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.[:]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[] 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 1 LE]Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions 5.®I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roofxepairs These sub-contractors have employees and have workers'comp.insurance.t 14. then ) 6.[:]We are a corporation and its officers have exercised their right of exemption per MGL C. � 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. $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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: I A) ')Vdl ► l� Policy#or Self-ins.Lie. Expiration Date: t _ Job Site Address: CW 1412 10 4qr. City/State/Zip: Attach a copy of the workers' compensation policy declaration page(s owing the policy number 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der he ins a dpenalties of perjury that the information provided above is true and correct. Signature: Date: Phone#• o I'`3t7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Y r _ f _�tf �, x �. .,- ":�_-;., y tF_.J, {7. •i?�� --sir �,•{�;r i"�i-,';moi �;^l-'y�'�J 1. -�. !'�i`f.{i 1���.:'J!�'Y1'v a��J'y�✓•.r",i'vzfl�. �. - 3 a i� '� �n"'i',,:�:- -__ Vat! V ILI pTHD AT SETS31I4C-'ES' I v� upau Adds 21,d Jip9�y req j Los: a; . 1 Z�r•Ar.wr.vrr e.r�%a r� I(r srirLn�a! va3z� i�dia�i�ts�raS�QRv _ T C nrs' zi§sns Ba5I3 ?Lu3 an12h M or?� > MAiB$ l;„,v1i r�t°1 3 s 1i �1 C i �>' �s� s err AMA N s �5 Fs�pac�t fro:`131ggola auk©l�cn�nt aiv osxt+n.' I i�, P I���Hi'JH�f •I��CX3�'1�'P f�l��t�__��.}��tIGE� aha6L)m f A K1lVNYS '- o•' al;va' •yl�p �tuf!�,•�V_`�.-.,�� . �, 9jnf9Qrurrelaay ---_... -• - -- -•--.. .__. ....:..._._ e _ - ..,_.� _ ."' . CERTIFICATE CIS- LIABILITY INSURANCE ! • 07/iJ20ia ( -MIS CERTIFICATE IS ISSUED ASA MATTER JF INFORNIATION ONLY AND CONFERS 11 RIGH79 UPON TI-!E CER IFICATE HOLDEA Tr1IS � I Ce iT{FfG i E DOES;M�-1� FiRhiATi FELY.0t2..fi�EOATNEI'l- MENP, ExTET4D Oil ALTER THE CJYER LGE A 1 ORDED BY THSPOLICIES TI CELQV!7: CHIS":CER71EE QF.1;}ISLi}7ANCE '­`z---'R hlOT CONS'FITIJTE A CONTRAGT BF t'tV E�1 THE ISSUING Il�F3URER(S), AUTr!ORJZED REPRESE�7T_. ...QR_Pf�� UGER,A"t�lIT.-HE GEK17F1CATE•HQEDER I IMPdA NT:* it certificate holder is an ADDYTIONAL:1NSUR!Fry,the Pol(oy(ies)must be endorsed, if SUBROG.iTION IS YJA1VED,subjsct to the farms and conditions o€the policy, certainpaLicit=$may.reg"u)ie an aadogsemenE A statama nt on this certificate.Roes not confer rights to the ceit'Iffc316 holder In-1166 of s6cit endoiS meint(s), PRODUC��gg - CO11 FACT MARSH USA INC:' ' "1; A TWQ ALUAfICE CEN i EER >= at(E FAX 3560 LENOX ROAD,SUITE 2400 No nuc NoI; ATLAN;fiA,.GA.303i6- amu' .. - AODRESS: INSURER"S AFFORDINGCOVERAGE 1004b2-HomeD•GAW 45-i6 ^" MAIC A$teatl(ast{{�su INSURED .: INSURER A:• i .rSnF�GOmF2nY 26367 7HD•AT-f10MESERVICES,INC. 'ItlsiiRI B:Zu•I(d1.Atijenah lasurance Co 16595 OBA THE HC1ME t1OTAT-HQME SERVICES -' 2690*0MBEFi1Ab ARK4YAY,SUITE 300 IHst7RERHamp's[ti(e iii"s Co• 23641 ATLANTA,Gt\30338. INsus R D V16 'A Company 23817 COVERAGES_ INstiR > s>•,:,._.. . - CER711=ICA71~NUMBER: X74' ." .REVISION,t�11NlBER�e.". T1i!S IS TO CERTIFY THAT Tt1E POLIC1ES.flF INSCIRPNCE LISTED RELOW HAVE.BEE[�_I$SUE[ TO THE,INSURED NAv1E(}A$Q�IE.FDIC THE POLICY PERIOD CERT[TED.'{NOTWfI HSTANE?IIVG ANY REQUIREMENT,TEt7M OR�p(41]!j IOII:;OF;A�J j;,CO T..A pFf QT(IER.DOC.i�(vjENT WITH"RE F'EC7 TO Vh{ICH TIi!S CERTIF7CATt MAY BE 15S.UED QR 14IAY PERTAIN, T}fE WSCt}7AFlOE APF(bRDED BY TFC-:p&I IES. ESt RiBED_1iEIZEtN IS 5i1�JECf TO ALL THE 7ER+ldS, EXCLUSIONS AND COIVD[TIONS OF SUCH F�OLLCIES;LIMITS S(TOWN NLA!(-!AVE BEEN REA .GED 6Y PA►C}.ELAIINS: " I,45P. • LTR TYPEOFINSADD UBRURANCE • . PO YEFF: °POLI YEXP POUCYNUMBER MIDDIYYYY MMIDo L1MIT5 A X COMMERCIAL GENERAL LIABILITY GLOOBT714�0'5 D31Dfr2015 0310112016 s1+�H occiil;aEric�, s 9,050,000 CL41M5}hADE OCCUR DA q E OREN�ED, .:•. LIMITS OF POLICY XS P12EtAISES Ea ocdirrence S . 1,05p000. OF SIR:SIM PER OCC /dED EXP.(Apy Brie person) 5 1 XCI UEO PERSONAL, 6V NY 5 g, APO GEN'LAGGREGATE LIMITAPPLIES PER: 9,1H10,�D0 X POLICY JELOC GENERALAGGP)GATE S OTHER: PRODUCT-C.OMPIOPAGG S 9,OW,000 ' B AUTOMOBILEUABILSII 8AP293!1863INGLES -12 . 53/0112015 03/0112016 CMBNED OISLIMIT S X ANY AUTO E'a accid'edl 1,Oa1000 ' ALL OWNEDSCF(EDULED BO DILYIfJJURY(perpeison) $ AUTOS AUTOS SELF INSUREDAUTO PHY DMG BODILYTNJUI2Y{oe;acc denq S HIREDAtITOS NON-0WNEO AUTOS PROPERTYgAMAGE - S Peracddent UMBRELLA UAB S OCCUR ETCH OCCURRENCE S EXCESS LIAR OCCUR • — _— - AGGREGATE - g DER C' WORKERS COMPENSATION WC51773i483(A05) 03/5112015 03/0112016 X PER 0TH- S C AND EMPLOYERS'LIABILLFY Yf N. STATUTE ER ANYPROFWADE 2)P"ARTNDEMF CUi1VE WC017731495(AK,KY,NH,NJ,VT) 03!011201$ d0112016 –`— Lille, OFFICEI(!((E}iQ'cg EXCLUDED? a NIA E(_EACH ACCtDENT• : S 1,000,O(A, (Mandalory to HH) • C01773t484(Fi) 03MI12015 53/01/2016 ,describe underEL DISEASE-EA EMPLOY S 1,000,000DCRIPTONOFOPERATIONSbalow ConttnuedonAddi6onalPage ELDISEAsq-PoucYUMTr s 5. OtSCRIPTION OP OPEPA'nONS I LOCA-nONS 1 VEHICLES(ACORD 101,Additional Rem*ariss Schedu EVIDENCE OF INSURANCE lg may hepttached it more space in required) CERTIFICATE HOLDER CANCELL A71QN THD AT HQME SRVIEES,LNG DBA THE HOME 0EPO7 AT-HOME SERVICES SHDULQANY OF THE ABOVE DESCRIBED PDUCIES BE CANCELCEa BEFORE' 2455 PACES FERRY ROAD THE EXpIRA-TION DACE THEREOF, NOTICE WILL BE'•DEL1VtRED IN ATLANTA,GA 3D339 ACCORDANCE WITH THE POLICY PROVfsi0N5: AUINO R1ZE4(2EPRESENTATNE - e Massachusetts - Deiaartrnent or COnStructiOn Supen,i or Speria:it License: CSSL-099823 t , B DZMTRY RO Y 4r4 Z 1?lp N air 70 N .RTQNAV Manchester NII Commissioner 06126f2018