HomeMy WebLinkAboutBuilding Permit # 4/27/2015 �ORYfi
BUILDING PERMIT R,
TOWN OF NORTH ANDOVER
IV
APPLICATION FOR PLAN EXAMINATION y _
Permit No Date Received rffo�Pay�S
gSSACHUS
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DES RIPTION F WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly —let 7 3
OWNER: Name: l Phone:
Address: � a
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ARCHITECT/ENGINEER 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: $ FEE: $ _
Check No.: q� Receipt No..
NOTE: Persons contracting with unregistered contractors do not have ac to the guaranty fund
Signature of Agent%Qwner _ Signature of contractor
VAORTH
Town ofEAndover
0
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z
O 4 WO _ h ver, Mass, 1
cocN�cacw�cK y
S V
BOARD OF HEALTH
Food/Kitchen
PERM� � IT T LIJ Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
has permission to erect .......................... buildings on .... . ... .. J� ,�l. .... ... . ... .... ...4.k. Foundation
Rough
tobe occupied as ..........I...... �.. . .. .... .... .. ... ............................................................. 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
e ITEXPIRES I ® THS ELECTRICAL INSPECTOR
. UNLESS C T TA. Rough
Service
..................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® OccupV PuildinRough
Islay 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 SALEM, NH,STORE#2382 STORE PHONE: (603)681-4218
541 SOUTH BROADWAY SALESPERSON:JOSEPH CAVALLARO
SALEM, NH 03079-4499 SALESPERSON ID:897831
Document Print Date: 04/19/2015
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
S QUENTARA COSTA 781-484-7203
® Customer Address Other Phone
45 WINDKIST FARM RD
L City State/Province Zip/Postal Code
D NORTH ANDOVER MA 01845
Installation Address
T 45 WINDKIST FARM RD
O Installation City Installation State/Province Installation Zip/Postal Code
NORTH ANDOVER MA 01845
MERCHANDISE AND INSTALLATION SUMMARY
MERCHANDISE SUMMARY
231056 : WOFVAUNIT : SOS : SOS 850 ARCH PELLA PATIO DOORS : 2-PANEL OUT-SWING FRENCH DOOR PATIO : PELLA CORPORATION -QTY 1
1049 : 87548 : STK : 1-4-8 RED OAK BOARD : 1-4-8 RED OAK BOARD : BABCOCK LUMBER -QTY 1
1161 : 1161 : STK : 1-8-8 SELECT PINE : 1-8-8 SELECT PINE : PRECISION LUMBER -QTY 2
19238 : 444 8PINE : STK : PNE CASE 444 5/8"X3-7/16"X8' : PNE CASE 444 5/8"X3-7/16"X8' : EMPIRE COMPANY, INC. (THE) - QTY 3
238353 : 2866 : STK : 1X3.5X10 RF EMBOSD PVC TRIM BOARD : 1X3.5X10 RF EMBOSD PVC TRIM BOARD : ROYAL MOULDINGS LIMITED -QTY 3
17 Materials Price $3373.75
Store 2382 Project No. 438421771 for QUENTARA COSTA Page 1 of 8
STORE COPY
INSTALLATION DESCRIPTION
Stock or SOS : Stock Door Type : Patio
Select Location : Basement back door Select New Door: Hinged/French
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 : 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 : Yes Describe Other Work Needed : pad out jamb
Other Work Charge : Yes Comments : No Comment
Labor Charges $ 604.00
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.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where In-
stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, 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, publi-
city, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left].
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..
Store 2382 Project No. 438421771 for QUENTARA COSTA Page 2 of 8
STORE COPY
TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable
SUB-TOTAL $3942.7
*TAX $ 0.0
DELIVERY $ 0.0
ORDER TOTAL $3942.7
BALANCE DUE
Work is to commence upon reasona e av it blity o Contractor which is anticipated to be h0h L lll� [fill in date].
Estimated completion date is 12 [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 $1,000.00:
] Customer to Pay in Full; OR
[_] Customer to use the following payment schedule:
(1) Deposit of$ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3)
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):
[_] 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$100.00, to be paid upon completion of the installation to both parties'satisfaction.
Store 2382 Project No. 438421771 for QUENTARA COSTA Page 3 of 8
STORE COPY
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON-
TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU
HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY
OF THIS CONTRACT AT THE TIME OF SIGNATURE.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142A
LOWE'S AND WNER HEREBY MUTU LILY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON-
TRACT, TH LOWE'S MAY SUBMIT UCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET-
ARY OF E EXECUTIVE OFFICE F CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB-
MIT T U AR ITRATION A OVIDED IN M.G.L. c.142A.
BY' Date:
L m Centers LLC
Y: Date:
Owner
By: Date:
Co-owner or Witness
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION
INITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION
EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES.
WITNESS OU AND(S) AND SE S) BELOW THIS T.* DAY OF 1,
Lowe's Ho enters, LLC
By: (Seal)
i
P ' t Name: L
Addre r a Owner (Seal)
City ate-/Province Zip/Postal Code
Print Name
(Seal)
Store 2382 Project No. 438421771 for QUENTARA COSTA Page 4 of 8
tAassachirselts -Dapartmftmt of Public Safety
Hoard of AUilding ReguilUons and Standards
C•„n�tn�ctlna Stiycrsis<.r
License: RS-081974
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7v WOBURN S'Jt~ 1�"
WM•'UNCTON IWA
Expiration
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OIIItct dlCubaamcr attklrs do$uelueso RteglaEion ["
MF IMPR!DilEMENrC0t1TRACT0R Qty-
! glstratian x.77467 Type:
plraUan 1-0046, Indivlaum
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.fQSEP11 MCNARY - i
767 WOBURN Sl'
WILMINC'i'ON,MA 01887 ,c•�•• ,
tlodermra4ry
The Commonwealth of Massachusetts
Department of htdustrial Accidents
Office of hivestigations
600 Washington Street
. ' Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLlibly
>Villlle (BusincsslO^r' ani ationilndividual):_ 3'0�'Crk
Addhess:_
City/State/Zip: U*61rI&Rhin 01 V7 Phone #:_ �� ` 7-:?q 3
Are you an employer? Check the propriate box: Type of project (required):
I.El I am a employer with 4• ❑ 1 ani a general contractor and I
cmployces(full and/or part-time).'`
have hired the sub-contractors (? El New conslnrction
2.El am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodcling
ship and have no cmployces These sub-contractors have 4. ❑ Demolition
working for me in any capacity. employees and have workers' 9. r_1xlc Buildino addition
(No workers' comcomp.insurance p• insurance. C�
required.] 5. ❑ We are a corporation and its 10,0 Electrical repairs or additions
3.❑ I ant a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL insurance
Roof repairs
insurance required.] # c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
\m'applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
' I lomcowtier.,who submit this affidavit indicating they are doing all work and then hire outside contrac(or.,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 start whether or not those entities have
cmployces. If the sub-contractors have employees,they trust provide their workers'comp.policy number.
I ani an employer that is•providing workers'compensation insurance for my employees. Below is the policy and job site
in/formation.
Insurance Company Name: .T. Mu 4v tL I �Yt$. ftowl of
Policy#or Self-ins. Lie.#:_ to CC_50D j5O J'4bO f 7,P01%46- Expiration Date: I I l
Job Site Address: Jr Wly)dis 1"jr11 - City/State/Zip: Al,l4hG1bv,� 11- of N
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 pataltics of a
line up to S 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 5250.00 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 herel?y certif ruder thepains and penalties of perjury that the information provided above is true and correct.
a:i n tturc: _/ Date:
Phone
Official use only. Do not write in this area,to be completed by city or town qfficial.
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
G.Other
Contact Person: Phone#:
9MCNA01 OP ID:DP
CERTIFICATE OF LIABILITY INSURANCE I °ATE`MAV°°"""'
04!01!2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the'pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
tho terms and conditions of the policy,certain policies may require an endorsement. A statement on this cartiflcato dogs not confer rights to the
certificate holder in lieu of such endorsomont(s).
PRODUCER CONTACT
NAME: David C Bruett
John J Wa16h Ins Agency,Inc PHONE
P O Box 4407 arc No E1,97$-745-330D (cAiC No:97$J45-9507
Salem, Br 04970.6407 ADDRESS:dbrue
David C Bruett tt@WalshinSurance.com
INSURER(S) AFFORDING Cpv>:RgpE I NA1C it
INSURER A:Travelers _
wsuREO Mcs%h McNatructlott INsuRERe A.I.M. Mutual Ins. Companies
767 Woburn Street INSURER C:
Wilmington,MA 01887 IN$URER0;
INSURER C:
INSURER F: �T
COVEFZAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICY;$OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NO"RMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE I$$UEo OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS:
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAId CLAIMS.
TYPE OF INSURANCENSR POLICY NUME;ER MRDLNDb EFF j LIMITS
GENERAL UAWLITY
EAC14 UC:CURRENCE s 1,000,000
A ! �tC—()MRIERCJA.'_GENERAL_IABILITY 680-6621P22A-16.42 . 02/0612015 02108120161Ret
CLAIMSWADE OCCUR I � v tea occ�xrc,u�l s � 300,00
MED EXP(Any a1�per•,a�) 5 5,00
N
BUSIne33 Owners � '
PERSONAL815DVINJURy s 1,000,000
GEGENERAL AOCIREGATE I S 2,000,000
''. NLAGGREGATEUMITAPAPPLIES
POLICY 171 100T 7
PRODUCTS-COMP/OPAtiG i S 2,000,000
LOC is
AUTOMOBILE LIARX-ny (Es&BcNdmtSt I
S _
'
ANY AUTO (Es
INJURY(Per
( ALL OWUFG i SCHEDULED
r AUTOS — AUTOS BODILY INJURY(Per,,x6d&,t) S
HIRFOAUTOS1 ANON/ftNED UTOS PROP
PER ACCIf 1A11
DENT 5
y
UMBRELLA LUSS I OCCUR
EACH OCCURRENCE (S
PJ(CE35 UAB
1 AGCREOATE g
I DED i RETENTION$— $ -
WORKERS COMPENSATION 44T.`STATU- Trt.
AND EMPLOYERS'UA1III.ITY _ .Ilia
B ANY PkoP lLT<>RJpARTTiER/E{ECtitvnY/N WCG6005014081-2014A 11/141201411111412016 E.L,FHACCIDENT 5 600,00
'OFF;CERtMEMe6REnLUDED? ❑;NIA
if e$.dtory in NN) E_L.DISEASE-EA EMPLOYE S 500,00
I!yei,describe ur,dat i
1 OESC;R;PTION OF OPERATIONS ML7W 01SEAfii;-POLICY LIMIT $ $00,04
I11PROPERTY 5,849
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACOAD 101,Addroonal P4Mar1ta Schedule,it more zpaen Ir roquirad)
Lowe'a Companica, Inc and any and all Subsidiaries ar5L additional insured
with rOSPOCt to commercial 90330--41 liabiity, WaiVms Of subrogation applies
pot written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVF DESCRIBED POLICIES BE CANCELLED BEFORE
Lowe's Companies Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
and any and all subsidlaries ACCORDANCE WITH THE POLICY PROVISIONS.
Attn:Vendor Insurance
PO Box 1111 AUTHORIZED REPRESENTATIVE
N Wilkesboro,NC 28656 Davld C Bruett
(019$8-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) Tho ACORD name and logo are registered marks of ACORD