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HomeMy WebLinkAboutBuilding Permit # 5/10/2016 BUILDING PERMIT OORTH TOWN OF NORTH ANDOVER .� #0APPLICATION FOR PLAN EXAMINATION it Permit No#: ®� � Date Received "ArEv CE BUSS Date Issued: ° IM RTANT: Applicant must complete all items on this page LOCATION CAVC Pr' t PROPERTY OWNER n W t,:1 tom Print 100 Year Structure yesno MAP` PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑Two or more family ❑ Industrial ❑ lteremRepa—ir, F1FJation No. of units: [ICommercial replacement Assessory Bldg Others: olition ❑ Other f'�'. � (i ctrl�u v;/ar YI ','1 uNrex r11i�r(ue1�'��K�I�df�:�Jlf '��r rr-�/ JIIM^ 1U!!ll +I. J r'f�rl�r��y"i��a!j/ lr�X�G' VIJ�%J`li//J/ �J/r4/�✓//ilJR4��IM�JJ�� 1 �f�� r DESCRIPTION OF WORK TO BE PERFORMED: ke(kV IV e\ALtOl� wkv)ADWJ Idem fication - Please Type or Print Clearly – 0 d :�;y n, OWNER: Name: tn a� a-d Phone: "" Address: n Contractor Name: Phone: Email Addressi Supervisor's Construction License ' Exp. Dater Home Improvement License: 5C7 Exp. Dater N ARCHITECT/ENGINEER Aff Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925,00 PER S.F. Total Project Cast: $ FEE: $ Check No.: t 660 Receipt No. k NOTE: Persons contracting with unregistered contractors do not Have access fo- guaranty fund n�� % .rr i,u/ �, No er,.r ./;./%/ d � �, i� .,.,1/�Df7//r/ii//7��im'°.�7. or/„n/lG�✓i . .,,iic/7r�iri�ra�///, ��/:; i..:, A/�i,/„i, 1;...,,r / ,....rr /r t / //, r f f/, F `4oRYM � -wftdover Town of "' All, o �- No. 10261 �� . h ver, plass, COC NIC"JW.CK V ADRATED P'P�,`'Cy S U BOARD OF HEALTH Food/Kitchen . PERMIT T LD Septic System 70 % o THIS CERTIFIES THAT .......... ,, .. BUILDING INSPECTOR ........... ..... .. .............. .. Foundation has permission to erect .......................... buildings on .. . . ... ........... ...... .. ........ ................. .. Rough 01 to be occupied as ...... ... ... .. .....�!'��.....J#W ................................ Chimney provided that the person acce tin his ermit shall In eve respect conform to the terms of theapplication e p p p 9 p every pFinal 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough 9-1 ,.........•. Service r :... ............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. ,i CONTRACT# 000335 i�{A SACf 1 S S� VICE "�5 71 fl1�i :t S� fi .ED S 4 Q #tACT LOWE'S AU_UaaIZED JREPRESENTATNE NUMBER CUSTOME�r- �MGL/ _- STOR O. STREET ADDRESS STREET ADDRESS 38Z Syl �� v�.t� 7, !o �vMAIW elf; CITY - s CITY STATE ZIP 6 OAA Nif U3Pv79 ti /�.vavtJ�iz ,r�r� of kyr .r - TELEPHONE . --.... ,... -: TELEPHONE - _' j' DATE LOWE'S HOME CENTERS LLCS MA HIC NO.:1486McasR REG This is Doty a quote fol the miudw and v?Myv.1i printed below;This bacornefl an agreement upon�ayrnreet.uP�n payn enl the aptve:`agreement x1t4Ma19 ihespedriat(y completed pages of this t, apd ConilitD CON[WflO wNY;ULfs tlocumeMsiM any oB�eraddenda antl attaahmegis hereto shall be refenadTohereiri'as tNs'"Conhaq, PLEASE itFAD ALLTERMS AND C6NDTf10T7SAtJ`T}IE IfEI RSE$IDEOF'rtiis PA(;E.AND 0110WING PAGE313EFORE SIGNING ": INSTALLATION STREET ADDRESS CITY STATE ZIP 23 J nL /9 &U-4 . Y5 0 itv U ti= c%IL t .Jt4- L_ I) iZvT�cr !t y710 FOv3o 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 installation?:[rrYes [ ]No -applicable tax included bw 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 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 specked is not included in this contract.Any changes or additions will be at an additional charge for the matedal 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,in ding,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 conr�ence upon reasonable availability of Contractor and/or any special ord�7 or custome ade Good(s)which is anticipated to be P%..L, �b 7U,L [fill in date].Estimated completion date is =I s /W 7D/b[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 COtytPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: 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,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 f j 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$100.00 to be paid upon completion of thg installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c.142A. By: Date: L/ B Lowe' Home Centers,L By:—� Date-k' ate /�$/ Z .X 7O16 t ,I> Owner Signature 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. 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 ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS DAY OF ADlLi L 0. Lowe's Ho Center C X z; Lowe's Autho ed Representative 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,ma; 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. � 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 a wwmyntis•s.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluml)ers Applicant Information J�1 Please Print Legibly Mime (tiusinch!(h;eunin11iun/Individual/: �OSP�CMr IVGI(t/ Address: -7 Uu t r 5[- ('itv/State/Zip: t l h M6 MV7 Phone #: j-7 �- 7aq-6)7-23 Are you an employer? Check the• propriate box: Type of project(required): Lb&lania employer with d. ❑ 1 am a general contractor and 1 employees(full and/or part-time)." have hired the sub-contractors 6. New construction 2.El ant a sole proprietor or partner_ listed on the attached sheet. 7. ❑ Remodeling ship and have no employccs These sub-contractors have S. ❑ Demolition working for me in any capacity- employees,and have workers' y ❑ Building addition [No workers' route. insurance comp. insurance.. required.[ 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions �.❑ I ant a homeowner doing all work officers have exercised their I i.❑ Plumbing repairs or additions myself. No workers' comp. right of exemption per tWGL 2 [ { I� ❑ Roof repairs insurance required.) ` c. 1.52. §1(1),and we have no employees. [No workers' 13.� Other conte.insurance rcyuiral.) �`` 1n, applicant that check;pox 4 must Aho lilt nut the,ection helow shmvino their workers'compensation policy inl(wmaIion. I homeowner,who suhmit 111k anidacit indicating they arc doing all work and then hirc,xtt.ide alntractnrs❑nt>t submit a new of fidimt uxlic:ming.uch. ('onu acn,r,111:11 check this pox nein attached an additional sheet showing the name of the sub-comractors and;tate whether or not tlto>r entitie,lime rmplotees. II 11u wh-cuntracton pace employees.they must protide their wot-kers'conte.policy nurttlxr. lam an emplaver that is providing workers'compensation insurance for my empl(qees. Below is the policy and job site ire for matiun. Insurance Company Namc:�•�. �. M r� L l a►1 S. rl l if — I otic\ #or Self-ins. Lie. 11: _� CC 500 J5 0�y �0 `a01%46 Expiration Date: Joh Site Address: 94 City/State/Zip: u Attach a copy of the workers' compensation policy de aration page(showing the policy number and expiration date). Failure to secure coverage as required ander Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ofa line up to S 1.70(1.110 and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of np to S250.00 a day against the violator. Be advised that a copy of this statcmenl may be forwarded to the Office of InvesliL,ations of the DIA for insurance covera•ve:verification. 1 do hereby certif uuler the pains and penalties of perjury that the itifcrrniation provided above is true and correct. inat are: Date: Official use only. Do not write in this area, to be completed by city or tower 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 0. Other Contact Person: Phone#:___ _ i /lp ifl I '%�j i,��/� �r �, /% �/��� � i�, /'jj//���/` 1, ;' � ) r� %,,,iii/ , i„i�� i i%� %��/ %i/%��� �i�j i ��!�� f�i�� ,�/% °i%� �'� ,,/� ,� ,�� ��� �����> /����ij oi,i,//� ,�, %��,�/i� �/% /� ��, � f �l , f � ' �� �� l 9MCNA01 OP ID: DP ' MDAY)I% CERTIFICATE LIABILITY INSURANCE 03116/2016 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: If the certificate holder is an ADDITIONAL INSURED,the policy(les) 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). PRODUCER CONTACT David C Bruett John J Walsh Ins Agency,Inc PHONE 978-745-3300 FAX P 0 Box 4407 A/c No Ext: (AC, Ac No):978-745-9557 Salem,MA 01970-6407 E-MAIL B David Cruett SS:dbruett@walshinsurance.com INSURER(S)AFFORDING COVERAGE NAIC A INSURER A:Travelers INSURED McNary Construction INSURERB: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: 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. ILTR TYPE OF INSURANCE D POLICY NUMBER MDLSUBR M/DD//YCY EYW MM/DDS LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 680-6621 P22A-15-42 02/08/2016 02/08/2017 DAMAGE:FORENTE PREMISES Ea occurrence $ 300,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea BIKED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ( ) AUTOS AUTOS accident Per BODILY INJURY $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT UMBRELLA LIAB OCCUR EACH OCCURRENCE $ '.. EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED 1 $ WORKERS COMPENSATION TW5 STATU- PTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/NCC5005014081-2015A 11/14/2015 11/14/2016 E.L.EACH ACCIDENT $ 500,00 OFFICERIMEMBEREXCLUDED? r--] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Lowe's Companies, Inc and any and all subsidiaries are named as additional insured as respects General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lowe's Companies, Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. and any and all subsidiaries Mail code:A3ESS 1000 Lowe's Blvd AUTHORIZED REPRESENTATIVE Mooresville,INC 28117 David C Bruett ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD