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HomeMy WebLinkAboutBuilding Permit # 1/26/2016 OORTH BUILDING PERMIT TOWN OF NORTHA V 0 APPLICATION FOR PLAN EXAMINATION Permit No : qi ,.A Date Received �SSAC"Us Date Issued: IMPORTANT: Applicant must complete all items on this page 1,,,�; �� � � / ; ,r«,n,,f�!��� If� ���,������rl������ 1 1 If riff e IN N,11 I i D I'll- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family 11 Addition El Two or more family 11 Industrial El Alteration No. of units: El Commercial I Repair, replacement Ei Assessory Bldg El Others: Demolition El Other ///,INE H DESCRIPTION OF WORK TO BE PERFORMED: 0 V) tAhOADW o lde�ntirl tion- Pilase Type or Print Clearly OWNER: Name: r Phone: 310 39 t? Address: 5 NeA AnJover, mo oaw ibull '10 0, /�� ,, ,� , , , a 11 � //i / , r , ,/„ ���� � , f ��/�/ ; Fq g�f ddress ����rrl��� r'� r���� ,.f „1� »�r�,,ror�//��� �r„, r,; �,,�„ ,,,, / /, o), 12 1 ,, , , , .F � J /� If����, ��rlrEx Date �����r� ����'f r/ ,,% r , , �� � � � , , t� , � , »�I�l1������� �, Ex ,Date ,,l�li,�� �,�„,� o I auemerr�����censera����1,.,�i r,,l l���il���� ,/, p ,,,, ,, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED C T BASED ON$125.00 PER S.F. 6� Total Project Cost: $ 0 FEE: $ — CheckNo.: Receipt No.: NOTE: Persons contracting it i unregistered contractors do not have ac to the guaranty fund SignaSignature Ag6nt/Owner of contractor FORTH -Town ot ndu v qL;r .. O t _ ® �.M h ver, Mass, 41 COCHI C Kl WICK y1' �d QDR�{TED ®'P��'�5 S U BOARD OF HEALTH AW MR PER IT 14111low D Food/Kitchen UL AV Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............. .. ..............I 0%" . ...® ...... .......................... ................ Foundation x0rhas permission to erect.......................... buildings on ........ .. . . ...... .......... . . .e. . ... p Rough • to be occupied as ....... .... .. .. .. ...... .. .... .b!!! .................................... chimney p . terms of the application e tin is�permit shall In eve respect conform to the to pp Final erson accrYrovided that the p g . provided p 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 '! ELECTRICAL INSPECTOR PERMIT EXPIRES IN 6 UNLESS CONSTRUCTI TAR S Rough Service A .......... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 8010290169 FIR Donnelley 072013.All rights reserved. 0667 [CONTRACT 9 4, MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT CUSTOMER LOWE'S AUTHORIZED REPRESENTATIVE NUMBER FS_T_0_R_E­N_0STREET ADDRESS STREET ADDRESS STATE ZIP CITY STATE ZIP �,A TI EP TELEPHONE CASH BAhK C, REG HIC t L DATE LOWE'S HOME CENTERS,LLC'S MA HIC NO.: 148688 CHARGE 6-0748358 FEIN:56 LOWE'S -.......... This is only a quote for the merchandise and services printed below.This becomes an agreement upon payment, Upon payment,the entire agreement,including the specifically completed pages of this document,the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this'Contract." PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING, INSTALLATION STREET ADDRESS CITY STATE ZIP AV jA .........<,, y \J .......... vi NOTICE TO CUSTOMER—PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually Will be installed based on the measured square footage of the Project Area.As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. Contract Total d tCutmer N 'cable tax inC Ud Are permits required for this install I 'Yes 0 *appr ....... NOTICE TO CUSTOMER: Federal law th Con vi I amp et 'at sign I' Ire d with the Reno ' R gh B i hazard exposure I to pro e you w P C f yr'k fith,lead equ s Lowe acknowledges having received a copy f this pamphlet before work began 'form ng Customer, the potential from renovation activity to be performed in Customer's dwelling unit. NOTE: If rotted wood is discovered during installation additional chi es of pp N I You will be given a quote and a change ordet must be completed and signed by the customer for any additionalIT Customer must initial. *Any work or material not specified is not included in this contract.Any changes or addit onsd ill be iAt'ari additional charge for the material and labor. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and in ependent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright, use and publish the photographs i I n print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including, but not limited to,marketing, advertising, publicity, illustration,training and Web content.By initialing here, Customer agrees to the foregoing. _[Customer to tial to the left]. —' Wr is to mence upon reasonable avail,ability of Contractor and/or any speQ14 �ustomer made Good(s)which is anticipated to be � fa [fill in date]. Estimated completion date is [fill in date]. ' Said`estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable, insert a statement of such contingencies), IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. CGJ " tOT THIS ,JON"ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000-00: ]" S "Customer to PayJnFutk',, OR I Customer to use the following payment schedule: r � (1)Deposit $ e —to be paid upon signing contract. Deposit should be 1/3 the total contract price;and (2)Payment of $ to be paid anytime after this Contract is signed and before commencement of installation,I[We authorize Lowe's to do one of the following(check appropriate box below): nt indicated above I ve anytime after the date this Contract is signed; Charge my/our credit card for the amount of the payme or Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3) Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142 I­Afc10 AN1r)n%A1K11=Q I-Ir-PPIRY NAI IT]JAI I Y AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS DISPUTE CONCERNING THIS CONTRACT,THA and Conditions included with this document and an other addenda and attachments hereto,shall be referred to herein as this'Contract." p This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon payment,the entire agreement,including the s ecificaily completed pages of this document,the Terms a y PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS "" CITY STATE ZIP T,.ro , 1 . � � t` e t 1 h,..,�t„ 4,. ) �u� >".� ,,,t.. r I � J � � . �1, 4 /' I`�.'�...Pr Vim, �i,t ' ' ' t"M, � , C ,V d� r C �b ., r ��.,.�,T�, l ,1....�r �`r, . � �` h„�� d� , d "e�. ��� wm N i4e"A01 NOTICE TO CUSTOMER—PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. Contract Total Are permits required for this installatharm2 �, ,J Yes [ ] No *applicable tax included .�,���o a, NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE: If rotted wood is discovered during Installation additional cha "es" 1I app Yau will be given a quote and a change order must be completed and signed by the customer for any additional carg , , Customer must initial. "Any work or material not specified is not included in this contract.Any changes or addit(�ons f4ill be” t an adddional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide, in perpetuity, Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing, advertising, publicity, illustration,training and Web content.By initialing here, Customer agrees to the foregoing. [Customer to initial to the left]. wo,rkl is too mmence upon reasonable availability of Contractor and/or any specirder r customer made Good(s)which is anticipated to be f "I 6 (I-I [fill in date].Estimated completion date is " I � 0' 111, [fill in date]. Said'estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable,insert a,statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SEGTION,ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [ ]Customer to OR [ ]Customer to use the following payment schedule: (1) Deposit $ tt, to be paid upon signing contract. Deposit should be 1/3 the total contract price;and (2)Payment of $ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ] Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3) Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.042A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH„DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- VR AFFAIRS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION ASfFtROVIE�ED IE OFFICE OF CONSUMER B1g2�FAIRS AND BUSINESS� .1. .- hN M G L c � Date: tL'owc s Ho rr)Ver Cet'tters/LL ` f g �-� Date: By Owner Si nature �f ,_ THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L.CA 42A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. Y SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF,SI9NATURE,. WITNESS,OURHANDS)AND SEAL(S)BELOW THIS DAY OF Lowpe Horne Ceq ^ �� I(entrs, LLC o., ,,, ,. 1 fl ,/ rtlr [ R�4r ,/✓`I(. (� P q, � �F✓ „r.,H,:e.v. f V Lowes Authorized Repregentative Owner Co-owner or Witness Customer acknowledges”receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. 55102 REV. 12113 RLE COPY' ©area yLowe a Lowes and the gable design are registered trademarks trademarks of LF Corporation. The Commonwealth of Massachusetts 1-e o Department of Industrial Accidents +„ Office of Investigations 600 Washington Street v)� Boston, MA 02111 :=a 144114'.tnas;s.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Niltllc lltusincs,lC7^r,anirnlion/lndivirluall: M +c Nkru ('ite/State/zip: t 1 6 tNl 012PI Phone#: 1-7 IT- 7-�q-bra 3 Are you an employer? Check the• propriate box: Type of project(required): II ant a employer with�_ `f• F-1I am a general contractor and 1 rntplovccs t Dull and/or pan-time).* have hired the sub-contractors b. ❑ New conslrttction Y 2.❑ I am it solc proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling .hip and have no employees These sub-contractors have S. ❑ Demolition working for me in any- ! ca city. employees and have workers' p` <). ❑ Building addition INo workersconip. insurance comp. insurance.- rcyuired.) 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions ntysclf. No workers' coot right of exemption per,NIGL p. 12.❑ Roof repairs insurance required.] ` c. 152. §1(4).and we have no employees. [No workers' 13V Othej;1,21w comp.insurance required] ';1n\ :ylplicam that check,ho.x kl must also fill out the xectian helow showing,their workers'contlx•nsati(in police intormatit)n. Ilontcos1'ners slho suhmit this altidas it indicating they arc doing all work and then hire x isidc ionlractors must suhmit a new affidas it indicating wch. 't'ontr.loon that cluck this box must attached an additional sheet shot ing the name of the.uh-conlractors and;talc whether«r not(hose entities ha\c cmplmec'. II the.nh_contrailon hast employees.they must pnwide their workers'comp.policy nund-ter. 1 am an entph)Yer that is providing workers'compensation insurance for my emplgveec. Below is the policy cart!job site information. M In>urancc Company Name: .T. �. l-►U44 I -Til S• C0 ►1 tIffs - - Policy #or Self-ins. Lic. tf:._ ._ ...CC 50D J5 o I y 0$I _,*;l Expiration Date: .lob Site Address: �� � ��l��21� ,S7'• City/State/Zip: Attach a copy of the workers compensation policy declaration page(shovrmg the policy number and expiration date). Failure to secure coverage as required miller Section 25A of ivIGL c. 152 can lead to the imposition of criminal penalties of'.1 line till to S 1.500.00 and/or one-year imprisonment,as well as civil pciialties in the form of a STOP WORK ORDER and it fine of up to 5250.00 it clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance covera-c verification. 1 du hereby certif order the pains and penalties of perjury that the uifarntatio►t provided above is trite and correct. 'iinaturc: - Date: Official ase 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 d. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: I ronT•,I,�hm Wealsh In�urnnaa 978 74S gS57 19/11r?01S 10:30 OL,70 P 002/002 9MCNA01 OP ID:MM `� R® CERTIFICATE OF LIABILITY INSURANCE OA'211111201 YI'J 12/11/2015 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: It the certificate holder is an ADDITIONAL INSURED,the pof(cy(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), PROOUCER CONTACT John David C Bruett John J Walsh Ins Agency,Inc PHONE — 'FAX P O Box 4407 IAJC,No,E,,,:..978-745-3300_ (AVC.No): 978-745-9557 Salem,MABr01970-6407 ao RESS dbruett@walshinsurance.com David C t3ruett _ _ _. __ INSURERS)AFFORDING COVERAGE NAIC a INSURER A-Travelers INSURED McNary Construction msuRrR a.A.I.M.Mutual Ins.Companies Joseph McNary ----- - ---.._. ... - 767 Woburn Street INSURER c: Wilmington,MA 01887 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH12i IS TO C:=RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD +NOICATED NOTVViTHSTAN DING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO IAHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AEI. THE IERNIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C;LAIMS INSR "AODLISUB ___.. ..__ _ R POLICY EFF - POLICY EXP LTR TYPE Or INSURANCEINSR WVD POLICY NUMBER �. MM1D0lYYYY MMlDD1YYYY � LIMITS GENERAL LIABILITY I EACII CCCURRCtiCF S 1,000,00 _. ._ . A ( +MrRCr%+LGExERAtUr.0i1'TY 680-6621P22A-152 02108/2015 0210612016 PRDAl(A^Epr.1:Sr;S?Encciure:anTLgEfiTEO - --'.. 30_Q00 tdED EXP rAnyc p„rscn.__'_S X Business Owners 1,000,QOPERSONAL&ADV INJURY _..__. GENERAL AGGRFGAIF 13 2,000,00 fAN!./^,i:R;Gl.r%UlAIT APPLrti PFR _.. L PRODJ(;iS OMV,011 AGG . S 2,000,00 IIHrr LOC .- --. `... AUTOMOBILE LIABILITY CGI,IBINE0 S NILE HVITAN)AL;I0 i - r+;!I�� Ak-745 SODILY INJURY!Por acndc_oll. 5 NON-OV0,A1, nn?Ct:AV I US AL 1 OS j -'PI H ACCIDf'NTi._ _ LOVORELLA LIAR OCCUR EXCESS EXCESS LIAR i LA 1 YI f1RHE 4CE c _ .. ... .. C'_AIreS 1AADI' , AGGREGATE 14F IENi ION: --_ - WORKFR5 COMPENSATION 14C STATII i 0TH- ANO Fk1PCOYERS LIABILITY Y 1 N _. WC LIMITS B :;, Pr+:;lel::o t.- al,Eur xEC'L^11•L r' WCC5006014081-2015A 11/14/2015' 11/14/2016 EL EACH LcIDENr 500,09 ,:LNVF7./BER F'XCLJDE;1 N!A i ._._ ._ _.._ _._.... _- (Mandatory In NHI �- 1! :rurLo.,nd.,• NF1. SEASF-EA EMPLOY” 500,00 IiF S-_I,Wh7NO; rlai:fi41•Of:S'exa, -..-.--. ._.. E I. Last ASE-Poucv uFiIL s 500,00 i PROPERTY 5,84 I DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Lowes Companies, Inc and any and all subsidiaries are additional insured with respect to commercial general liabiity. Waiver of subrogation applies per written contract. i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE LOWC'S Companies Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Vendor Insurance AUTHORIZED REPRESENTATIVE PO Box 1191 N Wilkesboro,NC 28656 ,G�-_ij� �A ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD W) Pn<�s5si;httseEts -NPartrpn_nt of Public Safety Buird or Suiiding Regttlatlons and Standards, C'nnctrnctfOn SUpervivir Uchnae: C"81974 .ttlSB�[G MCNA,diY r: 767 WODURN fir %3 WJ.cM NGFON SA • / �`4t K,d ,1 .r • I lit •. Expiration �-`)n`miS5i4nCr o'{lit3/Tfl1g s Of71ct 6P Cooauinrr aura&Buelseae ReentaUon �0 ME IMPROVEMENT CpNTRgC70R egist�tlon: '{j7'S&7 Typo: ptrattnn: .lttifs Individual JOSEPH r.MCNARY h C�t:' Ile,�JA JOSEPl t MCNARY - '167 WOHURN Sl' VV1l-MINCTON,CdA 01897 . . UpBersecrUrry