HomeMy WebLinkAboutBuilding Permit # 3/16/2015 BUILDING PERMIT 0RT#-j
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TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit No#- Date Received
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Date Issued: L
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
El Addition Two or more family El Industrial
QAlteration No. of units: El Commercial
Demolition epair, replacement 11 Assessory Bldg 11 Others:
Demolition El Other
Mew
DESCRIPTION OF WORK TO BE PERFORMED:
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Identifi ti Please Type or Print Clearly
OWNER: Name: Atml MU) Phone:
- - -- 1
Address: 1 D A clo 01+ 6IN—
WINN",
/111/11/1001111`1
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/ a e�Ir� rouem nt l.r ns a�l���/���������1����/ , x , ,rr,
ARCH ITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED OST BASED ON$125.00 PER S.F.
4 q §
Total Project Cost: $_ ,3 FEE:
Check No.: (Z;Zn 5-7 q6 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the uaranty �n
igha' ture of Ment/OwnerSignature of contractor
0-41
t%ORTF$
Town of ndover
®
No.
�Th ver, Mass,
o CLAKE _4=4 W1 IN
COG KICMf WICK
O RATE®
u' 111111111kBOARD OF HEALTH
Food/Kitchen
PERMIT NEW Septic System
THIS CERTIFIES THAT ......Y.h.1 ,,, 1, �t ,,,,, ,, BUILDING INSPECTOR
.... ...... ...................... ...... .......... ...... ... .... Foundation
has permission to erect .......................... buildings on ... .. .. ......V�or..... ...............
Rough
to be occupied as 'MW .. ...... ... .. .#.......&I .. . ....................................................
Chimney
provided that the person Yccepting 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
IT EXPIRESI THS ELECTRICAL INSPECTOR
LESS CONSTRUC SItl
S 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 Approvedy 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
"J !�L*S 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' : PNE 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 VYL 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 availlablity of Contractor which is anticipated to be [fill in date].
Estimated completion date is L 1(,( l�% [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:
,L-]-Eostomer 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):
L]Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or
L] 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 OWES MAYSLIBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SEBVICE 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 UCH RBI, ION AS PROVIDED IN M.G.L. c.142A.
By: Date:_
Lowe s Home Centers, LLC
By: Dat ! I -~
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 PART/IES.
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS CJS DAY OF
Lowe's Home Centers, LLC
By Z. (Seal)
Print Name:
Store 1094 Project No. 431854625 for AMY MELLMAN Page 4 of 8
STORE COPY
Address
ner (Seal)
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
I ne L,umrnurrrveu1111 u 1Y1UNs(ici7UYe11s
Department of Industrial Accidents
- Office of Investigations
I Congress Street, Suite 100
Boston 111A 02114-2017
y www.mass.gov/dia
!Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 1 Please Print Legibly
Name (Business/Organization/tudividual): Micbdel
Address:_.--- 5 7Bn5+1 t
City/State/Zip: � Phone
.Are you an employer? Check the appropriate box: Type of project (required).-
1.
required).1.❑ 1 am a employer with 4. ❑ I am a general contractor-and [
employees (full and/or part-time).'
have hired the sub-contractors 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 word, ers' q ❑ Building addition
[No Nvorkers' comp. insurance comp. insurance.!
5. We are a corporation and its 10.❑ Electrical repairs or additions
required.) ❑ P
3.❑ 1 am a homeowner doing all work officers have exercised their 1 I.F-1 Plumbing repairs or additions
yself. [No workers' comp. right of exemption per NI,GL 12.0 Roof repairs
insurance required.] -r 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 inCom anon.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside!contractors mast 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
employces. if the sub-contractors have employees,they must provide their workers'comp.policy number.
/airy an emploi=er t/tat is providing workers'compensation insurance for nrjij employees. Below is the policy and job site
InStlrance Company Name:
Policy it or Self-ins. Lic. #: _ Expiration Date:
Job Site Address: es' 'City/State/Zip: 1"1. ` .n [0V 61M
Attach Attach a copy of the workers' compensation pol'cy declaration page(showing the policy number and expiration (late).
Failure to secure coverage as required Colder Section 25A of MGi_ c. 152 can lead to the imposition of criminal penalties of Et
tine up to x;1,500.00 and/or one-year imprisonment, as well as civil penalties lin the form of a STOP WORK ORDER an(] 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(if) hereby certify under The P#ins and Penalties o4ger'ug that the information provided above is true and correct.
Si mature:LI--
Date
Phone #: 1 4 7X' 530 -717Y
Of use only. Do not write in this area, to be completed by city or town official.
City or Town: PermitlLicen'se#
Issuing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contaet Percnnt Pho„i, U.
z
'bass rr hu-sept'l, Departmentof'Pubfa f
Soard of
LJCer'Se CS-082193 �
MICHAEL T UNTIL
5 BRISTOL ST
LE I1I ,
� t
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration_ 162722
Type: Individual
Expiration: 4/6/2015 Trtt 238965
MICHAEL THOMAS DEMILLE
MICHAEL DEMILLE
5 BRISTOL ST
SALEM, MA 01970
Upd;aty Address and return card.Mark reason for change,
2au.o5,i Ll Address C Renewal ❑ Employment Cost Card
WTI--of Consumer Affairs&Business Regulation License or registration valid for individull use only
p� h
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� . Ira
r _ ,�30ME IMPROVEMENT CONTRACTOR before the exon date. If found return to:
egistra6on: 162722 Type: Ofrice of Consumer Affairs and:Business Regulation
' < piration: 4/6/2015Individual 10 Park Plaza-Suite X170
Roston,I%1A,02116
MICHAEL THOMAS DEMILLE
MICHAEL., DEMILLE
5 BRISTOL ST
SALEM,MA 01970 --
Unacrsecretary Not valid without signature
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CERTIFICATE OF LIABILITY INSURANCE _ 08/29/2014
THIS CERTIFICATE IS ISSUED ASA MA77ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATEDOES S NOT AFFIRMATiVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE CGVERAOE AFFORDED BY THE POLICiF_8
BELOW.THIS CERTiNCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THF.CERTIFICATE HOLDER.
IMPORTANT Irttlo Certificate holdor Is cut ADDITIONAL INSURED,the Polioy(los)must ba ondorsnd,If SUBROGATION IS WAIVED,subjoct to tho
tonins and conditions of the policy,cortain Policies may require an ondorcomont,A statomont on this corti irato dont;not Confer rights to the
cortificato t ! r In lieu of such ender om nt s.
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