HomeMy WebLinkAboutBuilding Permit #894-12 - 146 RALEIGH TAVERN LANE 6/13/2012 00RTy
BUILDING PERMIT OF�i�aD #6Ati
TOWN OF NORTH ANDOVER o� � -
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWER-AGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
4
HEALTH Reviewed on Signature
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
DAV Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT Temp Dumpster onsite yes no
Locbted,at 124 Mai Street
Fire Dep artmenttsignature/date = •�
Y
COMMENTS
i
I
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
i
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 21 A—F and G min.$100-$1000 fine
NOTES and DATA—(For department use)
i
® Notified for pickup - Date
I
E
Doc.Building Permit Revised 2008
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
"Roofing, g 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
i
❑ 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/Crossection/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
N OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
a
❑ 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
L Engineering Affidavits for Engineered products
V®TE: 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location f 6 ��/'�� aU�' le: + r
No. 2 Date
' TOWN OF NORTH ANDOVER
• �` Certificate of Occupancy $
j Building/Frame Permit Fee $ 36
Foundation Permit Fee $
Other Permit Fee $ ,
TOTAL $
4
Check# ?�✓`9" a
25407 Buis irf,Inspector
NORTH
® of over
.....
No.
ti I rK1
C% o , over, Mass., a- °° IL
COCHICMEWICK ^
ORATED
BOARD OF HEALTH
Food/Kitchen
.PtRMIT T U Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT. Z ./ '
..................................................................... Foundation
has permission to erect......................................... bwldings on ..0....�a... .... .��... .. h...`✓...:...�...�Y........... ............. Rough
to be occupied as....... ............................ .... Chimney
.....................................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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 IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION S TS Rough
......................... .............. C .."L:-:............................ Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE smoke Det.
Prinrt . ,
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 1 Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individtial): R&(Ala %VIC ilo
Address: 101k AUS C. .
City/State/Zip: 01160 Phone#: V?_ 53a- fl352,
Are you an employer? Check he appropriate box: Type of project(required):
1. 1 am a employer with 1— 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.ElI 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' 9. E] 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 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c.,152, §1(4),and we have no
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 information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors 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 entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name: 2 m er i co n Ta5urancGrn aany
Policy#or Self-ins. Lic.#: 6�6 Z U5–y 70 5 P011 Expiration Date: �� a
Job Site Address: !4 t4it# U flrh Line City/State/Zip: N,4ol�i r /nJ ofli
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
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 pains andpenalties ofperjury that the information provided above is true and correct.
Signature: .. .._ .._... _ . .. _.. ... . _.. ...... ....... _ Date: . _ ... ..
Phone#:
Official use 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 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
r. ✓!e -�ouuea� oo�ff' GA�iac/%�aella _
\ Office of Consumer Affairs&Bdsiness Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 133414 Type: Office of Consumer Affairs and Business Regulation
Expiration: 6/27/2013� DBA 10 Park Plaza-Suite 5170 Boston,MA 02116
RONCO CONSTRUCTION `
RONALD WACHLIN , J
12 TUCKERS CT.
PEABODY, MA 01960
Undersecretary Not valid without signature
�laxs:u'Itu�t'tts- Department of PjJI)IiC tiafct�
9 BOMA of Buil(lilp, .
Rc�ulation., and titantLu•ds
Construction Supervisor License
License: CS 71187
RONALD E WACHLIN
12 TUCKERS CT, 3RD FL
PEABODY, MA 01960
Expiration: 8/4/2013
( numi��ini•r
TrIV: 20503
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+" 11-01-11 ; f6: 12 ';patrick-j-woods-insurance 19788800023 ;9785318617 # 2/ 3
-A(;UJ�M CERTIFICATE OF LIABILITY INSURANCE io;63j2oii�
PRODUCER 978.531.2777 FAX 978.531..861.7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
P.3- Woods Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
40 Main St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
P.O. Box 353 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Peabody, MA 01960 INSURERS AFFORDING COVERAGE NAIC 0
INsuRED Ronco Construction, Ronald Wac in D/b/a INSURERA: COMMERCE INSURANCE COMPANY 347S4
12 Tuckers Ct. INSUR[R0:
Peabody, MA 01960 INSURER C:
INSURER D;
INSURER E:
COV BAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR V1 TYPE OF INSURANCE POLICY NUMBER MILICY EFFECTIVE POLICY EXPIRATION
UMrIs
GENERAL LIABILITY NV7121 11/03/2011 11/03/2012 EACH OCCURRENCE S 500.000
X COMMERCIAL GENERAL L',ABILITY DAMAGE TO RENTED $ 50.00(
CLAIMS MADE X OCCUR
L. 5 100
A MED EXP(Any unc parson) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $ 11(HIO,00
GEN'L AGOR£GATE LIMIT APPLIES PER: PRODUCTS-COMWOP AGG S 11000,000
X POLICYF—j LOC
AUTOMOBILE LIABILITY VK0743 02/14/2011 02/14/2012 COMBINED SINGLE LIMIT
ANY AUTO (Ea aWident) S
ALL OWNED AUTOS
A X SCHEDULED AUTOS ((PeDIPL�)RY $ 100,000
X HIREDAUTO6
BODILY INJURY $
X NOK%OWNED AUTOS (P&''"dertl) 300
PROPERTY DAMAGE $
(Per accident) ioo'000
GARAGE LIABILITY AUTO ON LY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY; AGG $
EXCE99/UAIB IELLA WIBILTIY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE $
$
DEUUCTIBLE g
RETENTION B $
WORKERS COMPENSATION AND I WC STATU- I OTH
EMPLOYERS'LIABILITY FR
ANY PROPRIETORIFARTNERIMCUTNE E.L.EACH ACCIDENT $
OFFICERNEMBER EXCLUDED? E.L.016EAOE-EA EMPLOYEE $
Wdeamoe under
SPECIAL PROVISIONS below E-L DISEASE-POLICY LIMIT $
OTHER
DESCRIPMON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDFA RY ENDORSEMErfr I SPmm FRO " -�
e s Companies,Inc & any and all subsidiaries are named as adl insured as respects to general
lability and auto 'liability.
005 Ford F550 Super Cab, IFDAX57YISE55445 2005 CARMATE TRAILER 5A3C816D45LO104538
000 CARMATE TRAILERS, 5A3C610SXL0004012 2002 DODGE DURANGO, 164HS78X62F118138
CE TE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
LOWE'S COMPANIES, INC, 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NA@tIED TO THE LEFT,
IS INSURANCE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P 0 BOX 1111 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REF17TATIVES.
WILKEBORO, AIC 28656 A D RIEPRESENTATNE
- t
ACORp 25(2001108) FAX: 336.658.2308 @ACORD CORPORATION 1988
STORE COPN
INSTALLATION SERVICES CUSTOMER CONTRACT- IUIWORK- INVEXT'/PATIO DOOR
LOWE'S OF DANVERS, MA., STORE# 1094 STORE PHONE: (978)646-9099
153 ANDOVER STREET SALESPERSON: EDWIN VELAZQUEZ
DANVERS, MA 01923 SALESPERSON ID:794346
Document Print Date : 06/08/2012
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 SKIVING.
Lowe's Registration or Contractor License Number/Lowe's Contractor Name
Lowe's Home Centers, Inc.'s MA HIC NO.: 148688 Lowe's Home Centers, Inc.'s FEIN: 56-0748358
Customer Name Home Phone
S KIMBERLY SERVING 978-258-4520
® Customer Address Other Phone
146 RALEIGH TAVERN LN
L City State/Province Zip/Postal Code
NORTH ANDOVER MA 01845
Installation Address
T 146 RALEIGH TAVERN LN
® Installation City Installation State/Province Installation Zip/Postal Code
NORTH ANDOVER MA 01845
MERCHANDISE AND INSTALLATION SUMMARY
MERCHANDISE SUMMARY
1161 : 1161 : STK : 1X8X8' SELECT PINE : 1X8X8' SELECT PINE : PRECISION LUMBER - QTY 2
7056 : 94710PINE : STK : PNE STOP 947 3/8"X1-1/4"X10' : PNE STOP 947 3/8"X1-1/4"X10' : EMPIRE COMPANY, INC. (THE) - QTY 3
131207 : 131207 : STK : 1 X8X16 PRIMED FINGER JOINT : 1 X8X16 PRIMED FINGER JOINT : IRVING FOREST PRODUCTS (MAINE) - QTY 1
327377 : 748171613215 : STK : 6' PELLA DR XO(LH) ADV LOWE ARG : 6' PELLA DR XO(LH) ADV LOWE ARG : PELLA CORPORATION -QTY 1
327777 : 7481 71 61 3253 : STK : 6PELLA DR XO (LH) INVIEW SCR : 6' PELLA DR XO (LH) INVIEW SCR : PELLA CORPORATION - QTY 1
Materials Price $ 1110.86
Store 1094 Project No. 355401838 for KIMBERLY SERVINO Page 1 of 7
STORE COP)
INSTALLATION DESCRIPTION
Stock or SOS : Stock 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 : Build in of jamb, ext trimadd oad
Other Work Charge : Yes Comments : on deck
Labor Charges $ 725.01
Detail Deduction -$ 35.01
Additional Specifications:
Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop-
erty is governed by Historic District Regulations.
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.
DTAL CHARGES OF ALL MERCHANDISE AND SERVICES •where applicable
SUB-TOTAL $ 1800.86
*TAX $ 0.01
DELIVERY $ 0.01
ORDER TOTAL- $ 1800.81
BALANCED
Store 1094 Project No. 355401838 for KIMBERLY SERVING Page 2 of 7
STORE COPY
`r Work is to commence upon reasonable availablity of Contractot-which is anticipated to be / - L` [fill in date].
�—
Estimated completion date is �� r/ [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 VS $1 000.00 OR LESS Customer must pay in full.
COIViPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1.000.000
[_] 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
[_] 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. .
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 LOWE'S MAY SUBMIT 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 TO SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A. i,. ,
Date:---- `�L
Lowe's Home Centers, Inc.
" Store 1094- Project No. 355401838 for KIMBERLY SF_RVINO Page 3 of
S.TORE COPN
s 9
Date: h
Owner
By: Date:
Spouse
THE IGNATURES 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 THE PARTIES.
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS DAY OF
Lowe's Home Centers, Inc.
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By: 1 E�i��.
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Address Owner
City State/Province Zip/Postal Code Print Name
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Co-Owner or Witness
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 clay after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of
this right.
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Store 1094 Project No. 355401838 for KIMBERLY SERVING Page 4 of