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Home My WebLink AboutBuilding Permit # 3/30/2016 BUILDING PERMIT a� %AaRvo-1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No Date Received uw,sPaE"�n� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION / °,- r ? � PROPERTY OWNER -- oWJ rT tV' o Print 100 Year Structure yes no MAP ' PARCEL: (, ZONING'DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building �, -bne family 11 Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: �❑ Demolition ❑ Other uiwrt9�nI�� IFr�'Wd`/ uvxir�r,Ayv ��/m/�,f r / t/ '� Mfr i;111i f��vci/ �ap�ISNJ��1uWl,V((�(rV�1,1!' rra� a�'%I% Y�l'fNrll�/ Gi,XN�4i/, ,r ,1,�,r �inrra rlyrr��m�1�"M�i°@fNCil"�Yd ��'//r /r/ir�llNl(f[�f1(,1%l��q�1� i I firlfJ DESCRIPTION OF WORK TO DE PERFORMED: Identification- Please'Type or Print Clearly OWNER: Name: r°e�7 � k(h bk riu7 6 Phone: Address: � t l l &4,w) Contractor Name: l("' � - 11'' Phone: 1 -m 220 - 7(7«,1 Email: Address: �.: ( Supervisor's Construction License: �I ' Exp. Date:_ /1�1 � Home Improvement License: Exp. Date: 1 ARCHITECT/ENGINEER 1 Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED OST BASED ON$125.00 PER S.F. Total Project Cost: $ � � FEE: $ 2,2. . Check No.: ,. Receipt No.: (�, NOTE: Persons contracting with untie istered contractors do not have access to-t*,5,�uaranty fun,,I- � r%/vGi�oG�,�i ',�,'�/, /r / r r,/ll /1/ '.,.,� h,,.,,,.1r0, /�,:�L✓.r/✓/lo,//i,,,�//i/u / :�� drL�,/./l. x..�i.�.� ,iavis..a+awer .9..rc.:..vca......�,e�u.�n/..�.,w,<,�,,,,,u.9..._. „�, .eunms».�v�.u�,:c�..v .,.ui./i.✓r✓miv�.uri, �.,.U.....�� ..r� ,. , NORTI-� Town ofAndover : ' _ °' O 0 ® Z oh ver, Mass, LAKE COC NICHEWICK[ S U BOARD OF HEALTH MIT LD Food/Kitchen Septic System THIS CERTIFIES THAT ,. BUILDING INSPECTOR ..................................................................� ..... ....... ......... Foundation has permission to erect .......................... buildings on .. .........1 ........................ ........... ek ®` Rough oft I ..to be occupied as ...... ...... . . . ........ . .. ...11,/1�� .$A............................................. 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S TS 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 Approved by the Building Inspector. Burner Street No. Smoke Det. CONTRACT# 13 rs e � � LOWE'S A THORIZED REPRESENTATI NUMBER = CUSTOMER STORE NO. S ET ADDRESS _. STREET ADDRESS _ Ib y CITY CITY STATE ZIP Al TELEPHONE TELEPHONE g12P--24-2 V 'x DATE LOWE'S HOME CENTERS,LLC'S MA NIC NO.:148688 - cnsH SANK CMG CHARGE '� .: FEIN:5S-0748358 - - - INSTALLATION STREET ADDRESS ��++_� CITY STATE ZIP `.aG�rr!r d 5 r i er r NOTICE TO CUSTOMER–PRICE CALCULATIONS:In order to properly perform the installafion 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 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 installation?:[d[f.Yes [ ]No *applicable tax Included 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 charges will apply.You will be given a quote and a change order must be completed and signed by the-customer for any additional charges. Customer must initial. *Any work or material not specified Is not included in this contract.Any changes or additions will be at an additional 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]. Work is to�q�mmence upon reasonable availability of Contractor and/or any special or_deer or/customer made Good(s)which is anticipated to be ///kS� [fill in date].Estimated completion date is 6!/�4V.- [fill in date]. Said estimated substantial completion date Is t of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows:— - ('rf applicable,insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: Y.)Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit $ 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,[Me 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.c.142A LOWE'S AND OWNER HERE TUALLY AGREE IN ADVANCE THATJN THE EVENT LOWE'S HAS A DISPU�E CONCERNING THIS CONTRACT,THAT OWE'S MAY SUBMIT SU DIS TE.TO A PRIVATE ARBITRATION SERVILE WHICH HASBEEN APPROVELY THE SECRETARY OF THE EXECUT= IVE OFFICE OF CONSUVER AF IRS AND BUSINESS REGULATIONS AND T-HE OWN RS ALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PR DIN . c14 //,�{ By: Date „f Lowe's Hom,Cent By. Z 12Zc_c Date: Owner eig nature 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.c.142A.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. BY 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 E TLED TO A COPY OF THIS CONT CTAT THE TIME OF SIGNATURE. WITNESS WITNESS OUR HAND(S) D SEA S)BELOW THIS DAY OF tP� Low ' om rs,L Lowe's Authorized Re OwAi` Co-owner or Witness Customer acknowledges recerp f 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. ®2004 by Lowe's ra a Lowe's and the gable design 55102 REV. 12/13 FILE COPY are registered trademarks or LF Co pora n. i i t ne q..urrernurnweuiirc uY crrusects t_. Department of Industrial Accidents Office of Investigation''s I Congress Street, Suite 100 Boston, AIA 02114-2017 J ��- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name Business/Organization/h7divid}ual : Address: 71 City/State/Zip: r+ D iq7 0 Phone Are you an employer? Check the appropriate box: Type of project(required): 1.❑ i am a employer with 4. ❑ 1 am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2 1 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 an for me in capacity. employees and have workers' Y } tY- 9. F-] Building addition [No workers' comp. insurance comp. insurance. 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 1vJGL 12.❑ Roof repairs insurance required.] c. 152, I(4) and we hae no employees. [No workers' 13-fn Other_(i,t comp. insurance required.] '.Any applicant(bat checks box#1 trust also fill out the section below showing their workers'compensation policy infonnatioct. Homeowners who submit this affidavit indicating they are doing all work and then hire outsidetcontractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-c'Ontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ani an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy tt or Sell-ins. Lie. #:_ Expiration Date: Job Site Address: �t G t �t/1 Dr 1 City/State/Zip: �" �V th�� ✓1119 °I �S 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 oi`up to 5250.00 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 under t e pUins and enalties o edu_ that the information provided above is true and correct. Signature: Date l _771 Phone 4: I7S- .530 -7 Official use only. Do not write in this area, to he completed by city or town offrciat Citv or Town: Permit/Licen'se# Issuing Authority (circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Caiitart Percnn: Phn'ne#- n. �I `` _f' ��!'?f' {(''C'- .�r?7�?C'•'%2�C1C�f.�fi�1Z• f�� '`�-�'�"j Office of Consumer Affairs'arid Business Regulation >� 10 Park Plaza - Suite 5170 a' Foston, Massachusetts 02116 Home Improvement Contractor Registration IC) Registration: 162722 Type: Individual r` Expiration: 41612017 Tr# 264526 MICHAEL THOMAS DEMILLE MICHAEL DEMILLE __----_-__�_ 5 BRISTOL ST SALEM, MA 01970 i Update Address and return card.Flark reason forthange. SCA t G aotitasv t �— Address n Renewal C-1 Employment lost Card L-1 r %f<.�ar�uznsrtr•en%!�r�r��.l�rrd�.rlwc!!5 _ IriceofConsumer Affairs&BusioessRegoladoo License or registration valid for individul u-e onty tT ME IMPROVEMENT CONTRACTOR before the expiration date: if found return to: m.. egistration: 162722 Type: Office of Consumer Affairs and Business Regulation '� ptration: 4)&2017individual 10 park Plaza-Suite 5170 T.MICHAELTtiOMAS.OEMILLE — _, Boston,MA 02116 5 BRISTOL ST –SALEM H1fi919ZQ_ -- ----- - Not valid without signature E: 4. lt? d• I 1 Il) i-•l r i I'J i n, bn o., o � N zti*a � v License" CS 2193 t . pe Visor s w MICHAEL T DEMILLE 5 BRISTOL ST SALEM MA 01970 421o Commissioner �r N a O.. on n. 0 v> 4-. 0 c�a