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Home My WebLink AboutBuilding Permit #129 - 36 BREWSTER STREET 8/5/2012 BUILDING PERMIT '.6 4. TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 4E Permit NO: Date Received c `"" " Date Issued: CHU IMPORTANT:Applicant must complete all items on this page LddA tl bN t PRORERTY-r'-OWNEW-a'� q, I A A.zx--i5# MAP NO' y PARCEL Jz N I NG,D'ISTRZf R r. Machine chnd ShopVillage :yes - no,, TYPE OF IMPROVEMENT PROPOSED USE Resiential Non- Residential New Building YQne family Addition Two or more family Industrial Alteration No. of units: Commercial -'4 Repair, replacement Assessory Bldg Others: qemolition Other -Wa-te"-fi"he Wetlands', - pain : 6'r, DESCRIPTION OF WORK TO BE PREFORMED: rep 04; 1b Q Idtification Please Type or Print Clearilt) OWNER: Name: t7ct�%4-1 Phone: Address: CONTRACTOR 'N ,,Phon i 7 4 e--s8:- :A'dde IlDa Supervisor ImprovementHome -x icense*--:,,.", ,pDate. . ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BOLDING PERMIT:MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 0"Y Total Project Cost: $ FEE: $ Check No.: <:9-C)Af--q Receipt No.: NOTE: Persons conte actfiFIngith eg'gled contractors do not have access to the gu antp fund f :Signatureb con of- nt/Ow'iiet. __gp*r Location t61 CS No. /01 • - TOWN OF NORTH ANDOVER 71 :>.. - ,• . � Certificate of Occupancy $ f Building/Frame Perr:pit Fee _ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#ao 25615 Building Inspector Plans Submitted❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF' ;SEWERAGEDiSPOSAL" Public Sewer ❑ Tanning/Massage/BodyArt ❑. . .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 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 ConnectioniSignature&Date Driveway Permit APW'Towo Engineer: Signature: Located 384 Osgood Street TIRE-DEPARTMENT _-Temp Dump''ster on site yes_. . no Located at 124 Mair Street- -Fire Department signature/date - f 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, wast or service drops 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 Pennit 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 �.. The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street 1t\ Boston, MA 02111 www.rnass.gov/dia Workers5 Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plllinbers Applicant Information - Please Print Legibly NaIne (Business/Organization/Individual): (� D (l, K�nnQ,4qu Address: City/State/Zip: C�� 01 Phone#.- �-7�� 360 — �japa Are you an employer?Check the appropriate box: l. 1 1 r Type of project(required): am a PrnnlnvPr juitF� ,'� 4. (ul I am a general rnnirarrcr and 1 r V, t,.•.00 /l;.ti a�„__,,... ha e hired the en},_.^ ��`'t:.!s ! ! 6. n New construction i?.ittytuy�.�,S�auu aiiww Ilat t-ti;tic1. v_ _e sub „„ 2.LJ I am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' B. Demolition [No workers'comp.insurance comp. insurance.# 9. ❑Building addition required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 plumbing repairs or additions myself- [No workers'comp. right of exemption per MGL insurance required.]t C. 152,§1(4),and we have no 12.0 Roof repairs employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indic tContractors that check this box must attached an additional sheet showing the namating such. e of the sub-contractors and state whether or not those entities employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. have I am an employer that is providing workers'compensation insrtrance for my employees. Below is the policy and job site information. Insurance Company Name:_ �1.T. f t"IwiVAI �V14>fbY1C�P Policy#,or Self-ins.Lic.#:� -0 oE aDater irte Job Site Adtress:_ 36 l�+�kIJ�C! JF City/5 tate/Zip U�r L t►'1 t� Q f�y 0. 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$250.00 a day against th iolator. Be advised that a copy of this statement may be forwarded to the Office of Investigatio the DIA for i/sfrance coverage verification. I do here y certi t n er t ns and penalties of perjury that the information provided above is trite and correct. Si nature: q Date: Phone#: I7op—360—17.2oa Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# Issuing Authority(circle one): ].Board of Health 2_Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Office of Consumer Affairs&Business Regulation TOME IMPROVEMENT CONTRACTOR Registration_,14688 Type � Expiratwvtb/$/2013 Supplement LOWE'S HOME$1q 1 . RICHARD CHAD.`. 136 TURNPIKE RD.SATE 100' _ SOUTH BOROUGH,MA 01772 Undersecretary A) I Niass-ncn Us2??s -]ate^;p:> .,r.' err :iil Bard';' �--1 Board c-3�iiding'Rea_lations and Standards _icense:CS-023355 = DAVID RETTANO 1 56 PLEASANT STREET METg>rTErP kA 01844 �aglmissicner 12/04/2013 1��8 RON HOMF IMPROVEMENT GDNTRACTOR Reglstrafion: . 108782 Type: �• di"r_7' Expiration: 8!252612 Private Corporaiio iN4L_ DAi�ID REITANO REMODEL&BUILD David Reitan 56 Pleasant St Methuen,MA 01 IYA Undersecretary j' -C1 eSS �LO 21 06 Tnr NORTH Town :ofs_E ndover .. Ol. No. h ver, Mas Z " • • s, T 2,9 -- 13 . COC MICnt W.C.. 4�R4" E o A''Qp�,`'�5 S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....6.•..�%.. .... `... 1.6t • BUILDING INSPECTOR Foundation has permission to erect .. ....................... buildings on ...... .......... �1�llu�. .... .. • Rough to be occupied as ... .. n p� .......�� .�. ...w �............................................................ 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ONS 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. SEE REVERSE SIDE STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF SALEM, NH, STORE#2382 STORE PHONE: (603)681-4218 541 SOUTH BROADWAY SALESPERSON:ANTHONY CORNACCHIO SALEM, NH 03079-0000 SALESPERSON ID:631180 Document Print Date : 08/02/2012 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 SIGNING 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 PHILLIP DAGATI 978-590-9618 O Customer Address Other Phone 36 BREWSTER ST L City State/Province Zip/Postal Code D ANDOVER MA 01810 Installation Address T 36 BREWSTER ST O Installation City Installation State/Province Installation Zip/Postal Code ANDOVER MA 01810 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 131203 : 131203 : STK : 1X4X16 PRIMED FINGER JOINT: 1X4X16 PRIMED FINGER JOINT: IRVING FOREST PRODUCTS (MAINE) - QTY 2 193569: 35170FJPMD : STK : PFJ CASE 351 2-1/2X11/16X7 : PFJ CASE 351 2-1/2X11/16X7 : EMPIRE COMPANY, INC. (THE) -QTY 3 193602 : 662 8FJPMD : STK : PFJ BASE 662 3-1/2"X9/16"X8' : PFJ BASE 662 3-1/2"X9/16"X8' : EMPIRE COMPANY, INC. (THE) - QTY 1 238345 : 2827-8 : STK : 3/4X5.5X8 RF EMBOSD PVC TRM BOARD : 3/4X5.5X8 RF EMBOSD PVC TRM BOARD : ROYAL MOULDINGS LIMITED -QTY 3 238348 : 2828-8 : STK : 3/4X7.25X8 RF EMBOSD PVC TRM BRD : 3/4X7.25X8 RF EMBOSD PVC TRM BRD : ROYAL MOULDINGS LIMITED - QTY 1 330285 : NEW CONSTRUCTION 313 : SOS : SOS UNITED WIND. RPL VYL PATIO DR : NEW CONSTRUCTION 3131 PATIO 6068 : UNITED WINDOW & DOOR MFG.INC. - QTY 1 Materials Price $ 831.0 4 Store 2382 Project No. 360019440 for PHILLIP DAGATI Page 1 of 7 STORE COPY INSTALLATION DESCRIPTION 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 : 00 Deliver Door: Yes Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit : Lowe's Permit Fee : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : None Describe Other Work Needed : sheathing decay below door and kickplate Other Work Charge :Yes Comments : therma clear glass stock slider Labor Charges $ 637.75 Detail Deduction -$ 35.00 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. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES •w here applicable SUB-TOTAL $ 1433.81 *TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $ 1433.81 BALANCE DUE Store 2382 Project No. 360019440 for PHILLIP DAGATI Page 2 of 7 STORE COPY Work is to commence upon reasonable availa lity of Contractor which is anticipated to be [fill in date]. Estimated completion date is [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$1 000 00• [gCustomer to Pay in Full; OR [//_]__Customer to use the following payment schedule: (1) Deposit$ 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. Store 2382 Project No. 360019440 for PHILLIP DAGATI Page 3 of 7 STORE COPY • By: Date: Lowe's H ent ra . � r By: Date: �2— Owne By. _ Date:— Sl2ouse 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 THE PARTIES. WITNESS OUR HAND(S) AND SEAL(S) BELOW THISDAYDAY OF,6: � . Lowe's Home Centers, Inc. By: (Seal) Print Name: G � Address (Seal) Owner City State/Province Zip/Postal Code Print 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 2382 Project No. 360019440 for PHILLIP DAGATI Page 4 of 7