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HomeMy WebLinkAboutBuilding Permit # 10/24/2016 NoRTy BUILDING PERMIT °R TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Receivedq°�R It �,y �$SRcFiusc Date Issued: !t { EVILPORTANT: Applicant must complete all items on this page LOCATION ' P nt _.._ PROPERTY OWNER ,,: ,: Pnnt '1�0 YearStructurs y nQ MAP PARCEL ZONING-DISTRICT Nrstorrc Drstnct ye no' Machrne Shop Village .ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑1NelI ❑ Floodplain C]Wetlands ❑ Watershed Drstrict ©1NafierlSev�ier ' DESCR PTION OF WORK TO BE PERFO MILD' � r� All Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: arLCt— re- �~ Contract Name: w �dn a Phone: Aditess Supervisor's -Construction'License. "` t EXp Date " ` Horne Imipravement,License_ ARCH ITECTIENG[NEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5 0 0 d FEE: $ Check No.: Receipt No.: NOTE: Persons cont acting witli unreg' tered contractors do not have access to the guaranty fund Srgnature of Agent/Owner Srgnature of contractor own of T ndover 0 No, 4 Y O LAKE h ver 1) Mass, _zvo n/a c oc"ICME WKK U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System CERTIFIES THAT BUILDING INSPECTOR THIS C .......LwrT. �.�. ........� . ..o v.Q..................................... has permission to erect .......................... buildings on .zq�...OJ0.4exeA....Sr............... Foundation Rough to be occupied as ;?.St...Q��t �P..It. ................. Chimney provided that the person accep ting 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 16 MONTHS ELECTRICAL INSPEGTOR- U LESS C T TI Rough Service ... . ........ Final BUILDING INS CTO GAS INSPECTOR OccupancyPermit Required to ®ccu BuRough 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. STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT LOWES OF SALEM, NH,STORE#2382 STORE PHONE.(603)681-4218 �' 41 SOUTH BROADWAY SALESPERSON: 1111 ALEM, NH 03079-4499 SALESPERSON[ ID: 1357741 Document Print Date:09121/2016 This is only a Quote for the merchandise and services printed below.This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agreement, including the specifically completed pages of this document,the Terms and Conditions included with this document,the applicable portions)of Lowe's receipt,and any other addenda or attachments hereto,shalt be referred to herein as this"Contract."PLEASE EAD THIS ENTIRE DOCUMENT.INCLUDINGT E"TE DIT! N "BEFORE SIGNING. Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers,LLC-MA HIC NO.:148688 Lowe's Home Centers,LLC-FEIN=56-0748358 Customer Name Home Phone. SOLD CHRISTINA CATIVO 978-771-3116 Customer Address Other Phone TO 245 BARKER ST 978-771-3116 City State I Province Zip/Postal Code NORTH ANDOVER MA 01845 PROJECT SUMMARY Category Comments/Scope of Work Amount Addendum Reference Barcode PROJECT SELLING No Comments $ 683.82 485628890 - PSI- F-ELECTRICAL PROJECT SELLING Customer declined shower door $ 3932.08 485621916 - PSI- F-PLUMBING PROJECT SELLING No Comments $ 1753.28 485628863 - PSI-FLOORING TILE PROJECT SELLING No Comments $ 3468.75 475941771 - PSI-GEN SVCS PROJECT SELLING No Comments $ 1406.68 485628947 - PSI- PAINT-MILLWORK Store 2382 Project Summary for CHRISTINA CATINO Page 1 of 7 .. ... ........................ ..... .. . .... . . .... STORE COPY PROJECT SELLING No Comments $ 978.75 485628908 - PSI- R-ELECTRICAL PROJECT SELLING No Comments $ 2948.50 485622040 - PSI- R-PLUMBING Materials Price $ 4330.161 Note: Please see Contract Addenda for a more detailed merchandise and installation description. Labor Charges $10911.7 Detail Deduction -$ 75.011 PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees the.right to take photographs of all work performed at the Premisis related to this Con- tract, 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 forego- ing. [Customer to initial to the left]. Additional Specifications: Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. 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. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable SUB-TOTAL $15168.8 'TAX $ 0:t1 DELIVERY $ DA ORDER TOTAL $15166.8 BALANCE DUE Work is to commence upon resonable availiabilty of Contractor andfor any special order or custom made Good(s)which Is anticipated to be i / e` [fill in date].Es- timated 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 fol- lows: (if applicable,insert a statement of such contingencies). Store 2382 Project Summary for CHRISTINA CATINO Page 2 of 7 STORE COPY NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s)are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form.This assumes sound ex- isting substructures,superstructure and points of attachments.Extra labor or material incident to installation necessitated by defective substructures,superstructure,points of attachment,or the moving of fixtures or appliances to be billed at extra cost to customer. IF T i full. COMPLETE THIS SECTION ONLY WHEN THE CONT A M/Customer to Pay in Full;OR L1 Customer to use the following payment schedule: (1)Deposit S to be paid upon signing contract Deposit should be 113 the total contract price;and (2)Payment of S to be paid anytime after this Contract is signed and before commencement of installation,t1We authorize Lowe's to do one of the following(check appropriate box be- low). L]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;or L1 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 5100.00 to be paid upon completion of the installation and both parties'satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s).BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SEI-FORTH IN THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NUCE REGARDINGI A N AGREEMENT FOR_QLAIMS COVERED BY MAL.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 DIS- PUTE TO A.PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE,0WNEFA SHALL BE.REQUIRED TO SUBMIT TO SUCH ARBITRATION A5 PROVIDED IN M.G.L.c.142A. '� f� Date: J Loweis'kome Cenlers.LLC By: Date: Owner By: Date: Co-Owner or_Witness THE IGNATURES OF THE P6RTIE,$ABQVE APPLY ONLY TO THE NT OF THE PARTIES RNATIVE 12.ISPUTE RESOLUTIONINITIATED BY LOWE'SNT TO MLL .14 A.TH M Y BE PERMITTEDTO INITIATE ALT RNAT V DIaPUTE RESOLUTION EVEN WHERF THE SECTION ABOVE IS N TEPER LY 1 NE BY PARTI WITNESS OUR HAND(S)and SEAL(S)BELOW THIS DAY OF Store 2382 Project Summary for CHRISTINA CATINO Page 3 of 7 STOKE COPY Lowe's Home Gpnters,LLC r f By: y .,7�` {Seal} (Seal) } Owner. -' Print Name:. { � }�7 %f€r�! f` 'v tya Print Name:- Address: � r -v' i. `rC1 fc�i Go-Owner orWitness:. (Sea[} CITY:__r xJ ? ;a State Zip ✓ Print Name: Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof.You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transactions.See the attached Notice of Right to Cancel for an explanation of this right. Store 2382 Project Summary for CHRISTINA CATINO Page 4 of 7 NOTICE OF RIGHT TO CANCEL 9,9 �' �e �2 ys �,A 'ek, a-19 (1 41 7.Sc)Y/77/ Your Right to Cancel t/`5 S � � /y 7/ I-/ ,�>"� Z y y °, y You are entering into LOWE'S Installed Sales Contract Number as � 6. t _ . he "Contract") that may result in a lien or security interest on your home in which property (the "Property" ) is to be in- stalled pursuant to the Contract. You have a right to cancel the Contract, without cost, penalty or ob- ligation, at any time prior to midnight of the third business day after the latest of (i) the date of the Contract, which is r�i 2j ,riv11� �� 7,r L (year), (ii) the date you received this Notice of Right to Cancel, and (iiiy if you have paid or will be paying for the Contract by using your LOWE'S private label credit card, the date you received your Truth-In-Intending disclosures in connection with such credit card. Effects of Cancellation If you cancel the Contract, the lien or security interest on your home is also canceled. Within 20 cal- endar days (except in Connecticut where the period is 10 business days) of receiving your notice of cancellation, we must: take any necessary steps to reflect the fact that the lien or security interest on your home has been canceled, and we must return to you any money or property you have given us or anyone else in connection with the Contract. How to Cancel It you decide to cancel the Contract;you may do so by notifying us in writing,by mail,telegram, or personal delivery, at: 1 You may use any written statement that is signed and.dated by you and states your intention to can- cel, or you may use this notice by dating and signing below. Keep one copy of this notice no matter how you notify us because it contains important information about your rights. To be effective, you must drop your cancellation notice in the mailbox, file it for telegraphic transmi cion, or deliver it to us by other means at the above address no later than midnight of C �h , , (year) (or midnight of the third business day after the latest of the thr6e events'listed above). I WISH TO CANCEL. (Customer's/Resident Owner's Signature) (date) Print Name ACKNOWLEDGEMENT OF RECEIPT OF DISCLOSURES AND CERTIFICATION On this 21 st day of September, 2016 (year), each of you hereby acknowledges receipt of two (2) cop- ies of the foregoing Notice of Right to Cancel; each of you who is a party to the Contract hereby ac- knowledges receipt of one (1) copy of the fully executed and dated Contract; if any of you has paid or will pay for the Contract by using your LOWE'S private label credit card, you hereby acknowledge having received the Truth-In-Lending disclosures in connection with such credit card; and you certify, represent and warrant to LOWE'S that you are all of the customers who signed the Contract and all of the persons who own and reside in the home in which the Property is to be installed pursuant to the Contract. ) f f � _ j .. f t.�t ✓t% (SEAL) tt,��.`l, w!; (SEAL) Print Nal a Print Name (SEAL) Witness Print Name NOTE : Each Customer who is a party to the Contract and each Resident Owner of the home must sign above. The Commonwealth of.Massachusetts Department of IndustrialAecidents r _ _ r Congress Street, Sr rte 100 a Boston,;HA 02114-2017 ~: q www.mass.govldra a'qsM sv4� WoVke& Compensation Insurance madavit:$uilders/Cnxxtxacta�rslEXectxitexansl'Xux>xbers. TOBBdFILFD WI:THTHI;pFpavJT j;MG.A.UT7rl_QRlt' '. P.leasePrint Lc 'bl A licant Information NaMe(Business/oigarhation/Ivdividual)' Address: City/State/Zip: Phone Areyou an employer?Check#Iie appropriate box: Type o-project(required): 1.Q I am a employer with_. einploYees(lulf and/or parE bane) 7. ❑N� i'ciinst¢iaatioxt 2. I am.a sole proprietor or partnership and no amplogees vaorking for rin $, ❑Nemo deliiig any capacity.[No workers'comp.insurance required.1 9. ❑Demolition. 30Iamahomeowner doing allworkmyself[Roworkers'comp,insurancerequired.7` 10❑Building addition 4,L]I am a homeowner and will be hiring contractors to conduct all work on my property. Twill 11❑Eleotrieal rap*s Or additioxms ensure that all Contractors either have workers'compensation insurance az are sola � - g xe airs or additions proprietors with no eariployees. 12Y�� Prep 5.0 I am a general contractor and I have hired the s h-contractors listed on the attached sheet. �3'.E]Roof rel airs These sub-contractors have einpIoyces mdhave workers'comp.insurance 14.'Cl Other g.❑We area cozporatioli and its,officers have exercised their right of'exemption per MGI c. vac 3rave no eurploYdes.[7n workers'comp.insurance required.] *Airy applicantthat ch oles boic#I daystit indfcahngthey are doing out the section allwork andtheuhire outside coniracfrs must suburr'a new affidavit indicating such tllomeownerswho submit•Yhzs,.- . . thBob must attached au additional sheet showing the n=';o£Yhe sub-contractors and state whether or not arose entities have tContractors that check is employees. Ifthe sub-coraizactazs have employees,they must provide their workers,comp.policy nuanbar. por Y am an employer tliut is pro compensation insurance far my employees. J3elow is flea ky aradyob site information. J surance Company Nanlc- Expiration Date_ policy#or Self-ins.Lac.#:. City/State/Zip: Job Site Address: thepolicynumber and expiration date). Attach copy ai''-the vs�oxkexs' compensation policy declaration page(shov�ixxg Failuxe to secure coverage as required.and r penaltiesinthe form of a OP xWOR1'ORDER a d a firte of up to $250.00 a and/or one-year imprisonment,as well as P day against the violator.A copy of this statement may be forwarded to the Office of Tnvestigdtions of the DIA for iiossuramace coverage-verif cation. r da hereby cer t�ander'thepairts ad penalties of�erjusy that tlxe infaxmatiorr p:avided above irs true and correct Date: Si afore: Phone#: rrof:ficlal use only. Do notlvr ite in this area,to be completed by city Or town offzciat • Per:mitlLiceuse� or Tovu: Issuing Authority(circic orae): ' j.Board of I'[ealth 2.Building pepartment 3.0ty/Tov n Clerlt 4.Electrical Iuspector 5.Plun Bing Inspector G.Other Phone#- Contact Person: i S C%74'7�irf�rairrnea�l�n�C i llr:�l.rr•/rr�e(�F � Massachusetts - Department of Public Safety �-�f zce Of &Business.Regulation! h gnlat;on Board of Building Regulations and Standards � ME IMPROVEMENT CONTRACTOR Construction Superl icor egistratton: 119623 ., License: C5-107986 Type: Expiration 8/6/2017 Dube Construction-Plus,>`ine - Supplement Card PE'T'ER J MACK 31 SCENIC DRIVE j PETER MACK DERRY INH 03058 M1 10 Bricketts Mill Road,Suite"C" E Hampstead,NH 03841 ri ,i «ti�` Expiration Undersecretary I 06/2612018 commissioner j3 'Y-..::. x w T i