HomeMy WebLinkAboutBuilding Permit #716-15 - 100 VEST WAY 3/16/2015 BUILDING PERMIT
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TOWN OF NORTH ANDOVER �� h ''- , •...*` �°�
APPLICATION FOR PLAN EXAMINATION _
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Permit No#: ` _` Date Received X19 Q°,
� f(> SSACHlJ
50
Date Issued: I I
IMPORTANT: Applicant must complete all items on this page
LOCATION
PROPERTY OWNER
t-� Print 100 Year Structure yesnnoMAP PARCEL:t (� ZONING DISTRICT: Historic District yesMachine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
❑Addition Two or more family ❑ Industrial
Alteration No. of units: El Commercial
epair, replacement
El Bldg El Others:
Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District
❑Water/Sewer
DESCRIP ION OF WORK TO BE PERFORMED:
Jr
Identifi ti - Please Type or Print Clearly
OWNER: Name: Q Phone:
Address: I63 VeS1
Contractor Name:
Address: tJ
J�-
Supervisor's Construction License: . . a ' Exp. Date:.
Home Improvement License: _. 6 ot7aa Exp. Date:
ARCHITECT/ENGINEER A Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED�gOST BASED ON$125.00 PER S.F.
Total Project Cost: $ 4 0)• �3 FEE: $ '{1�[ q1 —
-41 4
Check No.: 9,205-7 16 e ala 14 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantvAnd
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE"OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El
Well ❑ Tobacco Sales ❑
Food Packaging/Sales 0
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF: U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
• 4
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Perinit Revised 2014
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
Location /d l va
No. Date
• - TOWN OF NORTH ANDOVER
e.
r.
. Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#all,
Building Inspector
NORT1y
Town of �.: tAndover
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- _ '
soh to
ver, Mass,
COC NIC Nl WICK y�.
A�OArEO
S V
BOARD OF HEALTH
Food/Kitchen
PERMIT LD Septic System
A
THIS CERTIFIES THAT ....... ........A BUILDING INSPECTOR
�. ........................... ..�...!1N j.. .... ... ....^�............
has_permission to erect buildings on ...:I v4er Foundation
� Rough
to be occupied as .tq2q�......47,&�6.#....... L 1.4.(. .................................................... Chimney
provided that the person fEcepting 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
Yt1& PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCSil
S Rough
Service
...........r.0. .... .......................................... 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.
STORE COPY
INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK - INT/EXT/PATIO DOOR
LOWE'S OF DANVERS, MA., STORE# 1094 STORE PHONE: (978)646-9099
153 ANDOVER STREET SALESPERSON: BERNARD STUBBS
DANVERS, MA 01923-1450 SALESPERSON ID: 1503347
Document Print Date : 03/10/2015
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 agree-
ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any
other addenda or attachments hereto, shall be referred to herein as this "Contract."
PLEASE READ THIS ENTIRE DOCUMENT, INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING,
Lowe's Registration or Contractor License Number/Lowe's Contractor Name
Lowe's Home Centers, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358
Customer Name Home Phone
AMY MELLMAN 978-682-4437
O Customer Address Other,Phone
103 VEST WAY
L City State/Province Zip/Postal Code
D NORTH ANDOVER MA 01845
Installation Address
T 103 VEST WAY
O Installation City Installation State/Province Installation Zip/Postal Code
NORTH ANDOVER MA 01845
MERCHANDISE AND INSTALLATION SUMMARY
MERCHANDISE SUMMARY
1049 : 87548 : STK : 1-4-8 RED OAK BOARD : 1-4-8 RED OAK BOARD : BABCOCK LUMBER - QTY 3
1161 : 1161 : STK : 1-8-8 SELECT PINE : 1-8-8 SELECT PINE : PRECISION LUMBER - QTY 3
18302 : STK : PNE CASE 351 2-1/2X11/16X8' : PINE CASE 351 2-1/2X11/16X8' - QTY 9
99736 : 353 : STK : 6' RB VINYL PATIO DOOR SCREEN : 6' RB VINYL PATIO DOOR SCREEN : ATRIUM WINDOWS - QTY 3
238345 : 2827-8 : STK : 3/4X5.5X8 RF EMBOSD PVC TRM BOARD : 3/4X5.5X8 RF EMBOSD PVC TRM BOARD : ROYAL MOULDINGS LIMITED - QTY 9
444484 : 719801223722 : STK : RB 6FT 300 VYL PD LOW-E NO SCN : RB 6FT 300 VY.L PD LOW-E NO SCN : ATRIUM WINDOWS - QTY 3
Materials Price $ 1424.13
Store 1094 Project No. 431854625 for AMY MELLMAN Page 1 of 8
STORE COPY
INSTALLATION DESCRIPTION
Stock or SOS : SOS Door Type : Patio
Select Location : Back Door Select New Door : Sliding
Number of Doors to Install : 2 Side Lights or Transoms : No
Hidden Damage Description : None Number of additional holes bored for accessories : None
Install Specialized Mortise Hardware : No Lead Safe Practices : No
Stock or SOS : SOS Door Type : Patio
Select Location : Back Door Select New Door : Sliding
Number of Doors to Install : 1 Side Lights or Transoms : No
Hidden Damage Description : None Number of additional holes bored for accessories : None
Install Specialized Mortise Hardware : No Lead Safe Practices : No
Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : Yes
Customer Understands Scope of the Project : Yes Permit Required : No
Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None
Local Disposal Fee : Yes Describe Other Work Needed : b/o jambs.R/R SIDING ON 3 SLIDERS.
Other Work Charge : Yes Comments : 3 slider around sunroom.
Labor Charges $ 2012.00
Detail Deduction -$ 35.00
Additional Specifications:
Store 1094 Project No. 431854625 for AMY MELLMAN Page 2 of 8
STORE COPY
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 the 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 Con-
tract 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..
TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable
SUB-TOTAL $3401.1
*TAX $ 0.0
DELIVERY $ 0.0
ORDER TOTAL $3401.1
BALANCE DUE
Work is to commence upon reasonable/availablity of Contractor which is anticipated to be [fill in date].
Estimated completion date is L ( 1( <<% [fill in date].
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 existing 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 custom-
er.
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:
�cstomer to Pay in Full; OR
[_] Customer to use the following payment schedule:
(1) Deposit of $ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3)
Store 1094 Project No. 431854625 for AMY MELLMAN Page 3 of 8
STORE COPY
of the contract price; and
(2) Payment of $ to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap-
propriate box below):
[_J Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or
[_] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and
(3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON-
TAINED 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 SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY
OF THIS CONTRACT AT THE TIME OF SIGNATURE.
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 CON-
TRACT, THAT I 0WEq MAY RI IRMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET-
ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB-
MIT TOUC RB ION AS PROVIDED IN M.G.L. c.142A.
By: Date: -3/1 Or'
Lowes;Home Centers, LLC
By: Date
Own
By: Date:
Co-owner or Witness
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 SEPERATELY SIGNED BY TH PARTIES.
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS ICJ DAY OF �
Lowe's Home Centers, LLC
i
By: (Seal)
Print Name:
Store 1094 Project No. 431854625 for AMY MELLMAN Page 4 of 8
STORE COPY
(Seal)
Address ner � ...
-.a
City State/Province Zip/Postal Code rint Name
Co-Owner or Witness (Seal)
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 transaction. See the attached Notice of Right to Cancel for an explanation of
this right.
Store 1094 Project No. 431854625 for AMY MELLMAN Page 5 of 8
� Inc 11-UMmanweuctr1 of Irtuasetirruaecas t___ ,
Department of Industrial Accidents
Office of Investigation's
I Congress Street, Suite 100
.� Boston MA 02114-201�7
`' - www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information I Please Print Legibly
Name (Business/Organization/Individual): mitbael l ►I��C
I
Address:
City/State/Zip: (} o 1q7 p Phone #: 97 '7i7 f
Are you an employer? Check the appropriate box: I Type of project (required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contr4ctors 6. ❑ New construction
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 for me in any capacity, employees and have workers' r-1 Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions
-5.❑ I am a homeowner doing all work officers have exercised their I LF] plumbing repairs or additions
myself_ [No workers' comp. right of exemption per MGL
t
insurance required.] t c. 152, §1(4),and we have no 12.[] Roof repairs
employees. [No workers 13.[:] Other
comp, insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy ini'ormation.
Numeowners who submit this affidavit indicating they are doing all work and then hire outsidelcontractors must submit a new affidavit indicating such.
,Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entitics have
cu;ployces. lythe sub-contractors have employees,they must provide their workers'comp.policy number.
I ani an employer that is providing workers'compensation insurance for m�employees. Below is the policy and job site
information. j
Insurance Company Name:
Policy#or Self-ins. Lic, #f: Expiration Date:
Job Site Address: BSS f City/State/ZipA. AnbVerl.0 611
Attach a copy of the workers' compensation pol cy declaration page(sho wing 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
fine up to $1,500.00 andfor one-year imprisonment,as well as civil penalties'in the form of a STOP WORK ORDER and a fine
of up to$250.00 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 the p#ins and Penalties of
,Xedury that thein ormation provided above is true and correct.
Si nature: 1 Date
.11— - #�44 1 1 1
Phone #: 179-530 '7/-1Y
Official use only. Do not write in this area,to be completed by city or town official.
I
Cit_v 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
G. Other
(`hart Persnn- Phnnp it-
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441
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Y, *Massachusetts -Department of Public Safety
Board of But'dtna Regulations and Standards
License CS-082193
x MICHAEL T DFIvIU .L
5 BRISTOL ST
SALEM MA '01910
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Office of Consumer Affairs and Buslne'ss Regulation
10 Park Plaza - Suite 5 170'
Boston, Massachusetts 02116
Home Improvement Contractor Rebistration
Registration: 162722-
Type:
62722Type: Individual
Expiration: 4/6/2015 Tr# 238965
MICHAEL THOMAS DEMILLE
MICHAEL DEMILLE - -- ---
S BRISTOL, ST ' --- —
SALEM, MA 01970
Update'Address and return card.Mark reason for change.
Address E: Renewal ® Employment C Lost Card
_
•'�."/Ir`�'�i.�,rii�c:friwr�l�.,�'�^-�lrr✓rc/rr�./% --_ .�.__i �_. .�_.. I
� Officc of Consumer Affairs tic Business Regulation License or registration valid for individul use only
t3M1E 11fi R?VEMENT CONTRACTOR before the expiration date. If found return to:
egtstration: 162722 Type: Office of Consumer Affairs and Business Regulation
�. tration: 41fi120'15 Individual 10 Park Plaza-Suite$170
Boston,MA 02115 i
WCHAEL THOMAS DEMILLE
MICHAEL DEMILLE
5 BRISTOL ST �
SALEM,MA 01970
Undersecretary Not valid without signature
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�. CERTIFICATE OF LIABILITY INSURANCE 08/29r2014
THIS CER71FICATE IS iSSUEp AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HQLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE$
BELOW THIS CERTI):ICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT AETWEEN THE ISSUING INSURER(S),AUTHORIZED
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torins and conditions of the policy,certain policies may require an endorsement,A statement on this cortificato does not confer rights to the
certificate i r In Ilou of such ondorse f s.
PROCUCER
A Kelley
CCINTACT Brenda CatYotino
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Ciapent l yt Cot)treclor.
CERTIFICATE OLDER CANCELLATION
Lane's SHOULD Companies
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THE EXPIRATION DATE THEREOF C .6 Be DELIVERED IN BEFORE
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Alto.Is Insurance ACCORDANCE OTICE WILL 8E f)EUVLCRtT.OIN
PO Boy 1111 O CE WITH THE POLICY PROVISIONS.
North WilkesboroVET OR11EO R_PAt3 1t1TATIvE
N(` 2 8656 Katherine M. Kelley, AA1, CIC
ACORD 25(2009100 The ACORD name,and logo are registered marks'of ACORp9 ACORD CORPORATION.All rights reserved.
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