Loading...
HomeMy WebLinkAbout3 REPLACEMENT WINDOWS BUILDING PERMIT o�"4�T 6 �a TOWN OF NORTH ANDOVER 3r gw''``' APPLICATION FOR PLAN EXAMINATION '-, o - �ry w A Permit Na#: Date Received 3 TEo c CHU� Date]slued: - IlVIl'ORTANT: Applicant must complete all items on this page rin LOG TION Pnnf Yesr Structure yes no MAP PARGEL ZONING DISTRICTHrstonc Distract.: yes no Macllrne Shop Vrllage, ;yep no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family p Addition ❑Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial Repair, replacement Ej Assessory Bldg ❑ Others: ❑ Demolition ❑ Other =211 !� well ORO lodplain 11 Wetlands ❑ WatersYted District ewer DESCRIPTION OF WORK TO BE PERFORMED: U I G k Identification-� Please Type or Print Cle ly OWNER: Name: �� tn��- l ���v� 6 jbAeit Phone: )'? Y,� �;.7SZ 7 Address: nom ` _ EA e: -_: Phone_. �. I �� S fir/ S Mo. & 15 . (x Datensfirction';)-censeprnent License Exp. Dafie / _ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBA&ED ON$125.00 PER S.F. �-.__:Fatal Project Cost: $ _ , FEE: $_.. 0.3 Check No.: Receipt No.: NOTE• Persq s contracting wit unregistered contracto o not have:a s to the guaranty fund Signa ur of A ntfOwner Si rtr of coht_ractor, E ¢ NORTH Town ofndover 2 ;. : _ } 0 No. fl h , ver, Mass, / • cocn�cnew�[K �. �7 ,Q °RAreo S .S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..B•.#V....0*4-krillt # 0of J) � 1 �� BUILDING.INSPECTOR ,..... ... .......... ....... .......... ................ has permission to erect .......................... buildings on ..,. .., ,. t.1.'e ... `........................ . . = Foundation Rough to be occupied as ......., ......... P....... ! J........lI .R ...w.. .................... .... 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 Fina[ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T Rough Service ............... . . .._......._.,.. . ' Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Re uired to Occupy Buildin 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. !'qp Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126893 Salesperson Name and Registration Number: Richard 0 Donnell : R-1-073-13-00064 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: kseni—a-lel�edeva odonnell Boston North 9717032 First Name Last Name Branch Name Lead# 84 n st NORTH ANDOVER MA [01845 Customer Address City..StatL__e Zip 1(978) 828-7567 J Home Phone# Work Phone# Cell Phone# (astkafaVor Customer m,,E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address city State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEt NOTICE OF YOUR RIGHT TO CANCEL. Acknowledg4d by: 11/19/2016 X F.-a-m-es slo"turo Date Distribution:White- Home Depot Yellow-Customer Copy Contract Price and Payment Schedule: Payment of the Contract Price is due upon completion unless a different payment schedule is specified in the State Supplement. 2101.00 Includes all applicable discounts, rebates, and , taxes. Contract Price $ Excludes finance charges.* Minimum %deposit$ Due Immediately Remaining balance $ Due upon completion Finance Charges *Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payment(s) made payable to The Home Depot. Insurance proceeds will []will not V be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of Windows A more detailed description of the work to be performed is included in the section entitled Scope of Work which appears on page 3 of this Agreement. Anticipated Delivery Date/ Installation Schedule Approximate Start Date: 01/14/2017 Approximate Finish Date: 02/11/2017 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this agreement. By contacting your Service Provider, you may update your email address,withdraw your consent, or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. By ir'j1tJafi6g1.his paragraph, I consent to receive only electronic records related to this transaction. 'initial Acceptance and Authorization: By signing below, you authorize Home Depot to (a) arrange for Service Provider to perform Installation and/or(b)order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's/permitting information may need to be provided to You later.) By signing, you acknowledge that you have read, understand, and accept this Agreement in its entirety, including the General Terms and Conditions and State Supplement, if any. You further acknowledge receiving 4a, cc copy of this Agreement. Keep it to protect your legal rights. X 11/19/2016 Custo r's Signature Date X Co-SlgnGr(if applicable) - Dale -—---------- �77, 7 X /19/2016 Sates Consultant's 151,ofjnature Date 2 Distribution: White- Home Depot Yellow-Customer Copy Simonton Windows 71u 'r'aC`��- ori t a:e,4 �1E3�5 `•ljrl::l:�r:r,s �e alrnrpsirnt7r v'uni2i.a a'W��Dl�g�illC:lna VSnI!0'3.'.3, rllil�fi0 Argon Lo',1 Sin 531r.���3rn vidr'.o jarninad0 Con rejlllaS - J y CPD.SBP-A-44-21042-00002 07-75 DH ENERGY PERFORMANCE RATINGS EVALUACION OE RENC}IE41lENTO ENERGETICO U•�actcr Solar Heat Gain co; o ;c:ent _ v]dil:',5!'.:.. 3iil3i�i-s F?Fei3 J.:. 0,29 1 .65 r, 0.24 ADDITIONAL PERFORMANCE RATINGa EVALUACION SUPLEMENTARIA DE RENDINUENTo a Visible Transmittance 0.45 I • � �as'cF?:p,.ra..,..-.fds!aF��+n,srrr ,:73.13=^nr:-;rc� ��P".:a2r�gra : , 3 i JV,'-Ir-� r5 ,daf;3ft'LK _: .. ,.7CafVs.. .r amt" ai:" •. Cfy4�:' .�.�:a- nrn.l,C:..-.f:.a,�,.)hj sG1:4�.T f- su 3- e. °.lef':Y:f Y 3 9..;:L:.3i b3l�fiel.:::• ii+ci.;o: "af§,..r...t.,'r•A ier,.fl53;ti+-3..t.Cw.-a.d 3S�..E.J 7.3 aC i3� ..�.. -.3._�k_.d. ?!..,...�a... 't_:ae�s'"i di y a ��ei,7 . a J /40 Unit qualifies for ENERGY STARS region(s):Northern, Norah Central,n. South Central, n ��' �' STC:29 o Gu:Ifi�;.F IND:Rein 00/Glass ProSolar/H-LC25 D P.+.2 51-2 5 Tested Size:48"x 80" Florida Product Approval:FL5157 Applicable Test Standard(s): ANSI/AAMA/N. NWDA 1oi/4-S.2•-97,AAMAIWDMAICSA 10111.S.21A440-03,AAMAAWDMAICSA 1011i.S.2/A440-08, f A44081-09 Canadian SUPpl f 8858790,101 80333 HS Howard 6400094A CNE G:' _SF,b p8f8�:,sr:e,.Tai ar L=d j.;'.51 f.V.,wvv erw-ai SIR� ® DATE(MMIDDIYYYY] A ►z� CERTIFICATE OF LIABILITY INSURANCE 02/2412016 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 POLICII=S 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 I certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTERA1C Not, 3560 LENOX ROAD,SUITE 2400 -MAIL ADDRESS: ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE MAIC# 100492-HomeD-GAW'-16-17 INSURER A;Steadfast insurance Company 26387 INSURED INSURER 8:Zurich American Insurance Co 16535 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C:New Hampshire Ins Co 23841 2455 PACES FERRY ROAD,NW INSURER D:Illinois National insurance Company 23817 BUJLDtNG C-20 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL 003741310-08 REVISION NUMBER:O 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. S TR R TYPE OF INSURANCE ADOL SUE3R POLICY EFF POLICY NUMBER MMIDDIYYYY MMIDDY EXP LTR LIMITS A X COMMERCIAL GENERAL LIABILITY GL04897714-06 0310112016 010112017 EACH OCCURRENCE $ 9,000,000 CLAIMS-MADE M OCCUR PREM SELJ a occurrence $ 1,000,000 LIMETS OF POLICY XS MED EXP(Anyone person) S EXCLUDED OF SIR:$1 M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,000,000 X POLICY El PECOT- LOC PRODUCTS-COMPIOPAGG $ 9,000,000 $ OTHER: B AUTOMOBILELIAr3ILITY BAP2938863-13 03/0112016 03/01/2017 cOMBINEDSINGLEtIMIr $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person] S ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident o $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ S C WORKERS COMPENSATION WC015519215(AOS) 034112016 03!0112017 X s7TuPH ARrE AND EMPLOYERS'LIABILITY C ANY PROPRIETORIPARTNERIEXECUTIVE Y� N 1 A WOO 15519217{AK,KY,NH,NJ,VT} 03!01!2016 0310112017 E L.EACH ACCfDENT $ 1,000,000 D ------- OFFICER/MEMBER FXCLUDEO? WC015519216 FL 0310112016 03101/2017 1,000,900 (Mandatary In NH) { ) ET.DISEASE-EA EMPLOYE $ If yes,describe under Continued on Additional Page E.L.DiSEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS r LOCATIONS 1 VEHICLES (ACORD Ia1,Additional Remarks Schedule,may be attached it more space is required) i. is CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600OSGOODST, 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 Mukhe€jeeuoo �.�1�•.t`*��a-�s+ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD E Tlie C'onintonwofilth oj'Mrassuchuseds ' Depraronent of indu,striralAccidentY Office of Investibatiotu _1 Coatorress Street, Suite 100 �. Boston, M-4 02 1,1-2017 y� � ]�ww.mass.gav/die N�"orlcets' Gornpensation InsuXanee €idavit; BuildersIContractors/Electxiciansl'Iumluers 'lease p»t Le 'biv � APP licant bformation I I �� �[�e [BusinesslCh'ginizatiottllz�ld�i„€d_ual'}: I Address:—!!IaL Q sys Phone#: S C Cit<715tate/Zi : � °U� �� - Type of project(required): Are YOU an employer? Geek the ap rop Oat box: a general contractor and i 6. ❑New construction 1.❑ I am a employer with h ye hired the sub-contractors employees(full and/or part-time).* 7, Remodeling listed on the attached sheet. ❑ 2_❑ 1 am a sale proprietor or pm - These sub-contractors have g, [�Demolition ship and have no employees working for me in any capacity. employees and have,workers' 9. Building addition comp.III5llydrlCe. [No work comp.insurance 5. ❑ We are a corporation and its l0•❑Electrical repairs or additions required-] officers have exercised their l l.❑plumb' g repairs or additions g 3.❑ 1 am a homeovmer doing all wo& right ofexamptiou per IVIGL 12,E] fr airs ruyseLL �Ta workers' comp. c. 152, §l(q),and we have no izzsurance required.] employees. ala workers' 13. Other` +�1 comp.insurance required} cy urm . y applicant chat cheeks box#i must also fill out the section�dom elan work and then hire outside aoatractats rnuow ihoyAag ditir workers' hst suhtmit a new at�idavit indicaring seen l Horneovmers who submitthi5 a$idavlt izrdicatiag they g _ tContzactors chat check this hnxmust attached an additional sheet shovring the aaauc aftha suQl onb�and state whether ar not those entities halve employees. she sub•camractois have employees,they must provide their workers'comp,policy Y urn an employer tlaat is providing workers'cotnper:sation htstarance for!ny employees. Below is the policy and job site information. d �� - Insurance Company Name: `� r 1 Policy#or Self ins.Lic, #: a j f Expiration Data: f l CitylStatelZip: D Job Site Addreing the potiey amber and expiration ss: Attach a copy of the workers' co pensation policy declaration page(sho lead to the imposition of cruninal PenaltiesOfa I Failure to secure coverage as required under Section 25A of 1dGL c, 152 can P ! TOP WORK ORD e ug to$1,5 that a copy 00.40 and/or ane-year imprisonment,imprisonment,as of thiPens fm of up to$254. statemes in the form of a 9 ent may lie forwarded t the Office and a fore 00 a day against the violator. Be advised Investigations of the DTP.for insurance coverage verification, Ido hereby cerci under tlee pains arrd penalties of perjury that the information provided above is true and correct Si ature: / �J Phone#: t0 l E I rFO%fioclalnly. Do not write in this area,inbe completed by city or town off ictaln:ority(circle one):Health 2. Building Department 3.City/Town Cleric 4.Electrical Inspector 5.plumbing Inspector 4 $.Other Phone#; Contact Person; � es-,.Yj y 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: 8/3/2018 MARIA NIADNA --- _�___._.......:_. ... ._. 2455 PACES FERRY ROAD, HSC C-1 I ---- - - ATLANTA, GA 30339 Update Address and return card.Mark reason for change. Address ❑ Renewal ❑ Employment ❑ Lost Card ,--y�r`t`(fJ/r/1/r•rrrl Y•rr�/�r/r-'�(rqi irrrJrrr.;r//.J . ofCousunier Affairs&Business Regulation License or registration valid for individual use only i 3, r 1`r}tOIVIE IMPROVEMENT CONTRACTOR before fire expiration date. If found return to: Office of Consumer Affairs and business Regulation Registration: 126893 Type10 Park Plaza-Suite 5170 E;xplration' 813/2018 Supplement Card Boston,MA 02116 THO AT HOME SERVICES,INC. THE HOME DEPOT AT HOME SERVICES MARK NIADNA 2456 PACES FERRY ROAD,HSC ATLANTA,GA 30339 � Undersecretary Not vat"r without signature 9 ......... � •.u• $ •E l .y r - 'a;.,.;�~ § � '.� �,'� „ ��firi,¢� i ; wg rhn r�^w• ) T H 'ai.::': ,r•'S;.�-1� �a� cf'...:`r' ,...,•%�.. r 5� ; 1��.f-�--i '�� ,�,�,:�,� . .s i�•{'+�'. �3 j�, �,.. �C _�. ��9' ���( .�.'� t�,..� � �� �.,i•,S.�. 'e.J ���"tf, J. J L- ���.�,f .. - Plaistow �« in ` _ '..ter —,�.�—S..ti II..'. `,4�c`i h 1`:i.•,e.'4��:pia"�,. ',.' � �� � �. •r