Loading...
HomeMy WebLinkAboutBuilding Permit # 4/30/2015 BUILDING PERMIT OF OORTH TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Ll r�l Date Received c u Date Issued: —IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER V Print 100 Year Structure yesno MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes , no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 11 One family 11 Addition El Two or more family 11 Industrial -Ln 0 no no 11 Alteration No. of units: 11 Commercial 11 Repair, replacement 11 Assessory Bldg 11 Others: 11 Demolition 11 Other 4\00F DESCRIPTION OF WORK TO BE PERFORMED: �Dul Identification- Please Type or Print Clearly I OWNER: Name: JU i Phone: Address: Contractor Name: 2- Phone: -7'7 41- a 17 'a� 6,2 -i( Email: W t J,)c" rx)Grm Ca y-) Address: he/Supervisor's Construction License: , ' - 10 eq C) Exp. Date: �L)/� Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEDON$125.00PER S.F. Total Project Cost: $ FEE: $ Check No.: e2, - ()"2-C1sUL, (,an Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acc ss to theuar y nd t S-9 n—2f U r�--,p h i I, her, ORTH Town of Andover 01 No. ver, 3o 2AI 5-mv Mass, C' O'�ATED BOARD OF HEALTH Food/Kitchen rERMIT D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT .................... ................ .................. ........ej.19.a......................... Foundation has permission to erect .......................... buildings oil .....1!5.3.....!"......................................... Rough 4k tobe occupied as ............ .........................................I........................ Chimney provided that the person accepting t is 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final ELECTRICAL INSPECTOR PERMIT EXPIRES Rough INIFNTHS Service UNLESS CONSTRUC S 01 ............. ... ..... ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occu ancv Permi-t R luired to Buildi Rough A Final il the Premises — Do Not Remove JIM` Display in a Conspicuous Place on 111,11 FIRE DEPARTMENT 1 No Lathing or Dry Wall To Be Done 11 Burner Until Inspected and Approved by the Building Inspector, Street No. Smoke Det. (coNrancT - 3 r i SERVICES SOLUTIONS INSTALLED SALES CONTRACT t ES AJrH ORI Z co REPS SE NATIVE.-... r u le[r CUSTOME"i `--` ---- sTt3RC:" ) � S7F ET FCJR_SS � E S7PEEr nt i 5 _ 33 t 7l, CeT'( t t 's t Y , r is -1 L t .. f ir'. ,i f t t ..n..r i f a,_ i:�T,R.,.�T1"+rO.�G�FiJ�,.�.s ''E RE4 eR__51pr,yr,.Sa.E f*?.U�:r..J F,4t,0.,Pf.,PAGE SzC.>err ORE SIGNING kPr5 'i ........._........ . NOTICE TO CUSTOMER-PRICE CALCULATIONS:In order to properly perform the installation of cenain 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 Ptice stated in this Contract is calculated upon both .' the value of estimated Goods required to fulfill ilia Contract(including waste),which,may exceed the actual square footage of the Project Area,and the labor which maybe - ' estimated based on the amount of Goods required to fulfill,the Contract(Inc udmg — waste).By signing this Contract below,Customer acknowledges receipt of this notice 1 Contract Total I and agrees and understands that ti;e Pace'includes these costs which may not be .'applicable taX$8 inClUded '-•' ` -- refunded once the Installation Sery ces are performed. NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamphlet Renovate Right.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. NOTE:if rotted wood is discovered during installation additional charges will,apply.You will be given a quote and a change order I must be completed and signed by the customer for any additional charges �' -Customer must initial. 'An rare or Material nor s)c-ra6e•3 is nor in^!udco in this�,W`It!_Rny changes or adpr�ens wilcontracto ddlfiorat charge for the material and tabor. Yf be PHOTO RELEASE!Customer grants to Lowe's and Lowe's employees and independent s the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's at'right,title and j interest in and to the photographs for use in all markets and media,worldwide,in perpeluity.Customer authorizes Lowe's to copyright,use and publish the photographs in print ar,d'or electronicafly,and agrees trial Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing, advertising,publicity,Illustration,training and Web content-By initialing here,Customer agrees to the foregoing,- {Customer to initial to the left). Work is to corn_ntonce upon reasonable availability of Contractor and/or any special order or customer made Goods)which Is anticipated to be I - _(fill in date).Estimated completion date is €• [fill in dale). Said estimated substantial completion,date is not of the essence.A statement of any conte 3a.,Cies ilia,would materially change said est,mated substantial 1 coinpletion data is as fc0ows:— -- — --------- --------'---- _..—.._--------------- ----...----._..__....---._..__......__.__...._._....._._....----.—— (it app;cable,insert n statement of such contingencies). I This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION,Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract(EXCEPT for matters that may be taken to SMALL CLAIMS COURT),Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING.But the arbitration 1 procedures are SIMPLER AND MORE LIMITED THAN RULES APPI.ICABI,E IN COURT.Arbitrator decisions are as enforceable as any court order and!€' are subject to VERY LIMITED REVIEW BY A COURT.FOR MORE DETAILS:Review the section titled ARBITRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract, t DO NOT SIGN THIS CONTRACT UNTIL COMPLETE AND YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON ALL PAGES OF THIS CONTRACT.BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON ALL PAGES OF THIS CONTRACT,YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. p WITNESS OUR HA 0fkS)AND SEAL(S)BELOW;HIS__t CA"C7F- __.�__ _.. Lowe's Home Centers, LLC t . �iJ�aaer 1 Lctra. hu ho`zed Repro_entaliva Gs;oamor or Wanes Custorner acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer'.,execution heroof,You,tho buyer,may cancel tills transaction of any time prior to midnight of the third business day after the date of this transaction.See the attacher/notice of cancellation form for an explanation of this right, COPY5REV, 12/13 FILE Sfk?k „ The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 a d Boston,MA 02114-2017 www.mass.gov/dia 1 SV�V • Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le ibl A licant Information Na1T10(Business/Organization/Individual): Address: 1 ^' fcdo (�` City/State/Zip' ` N Phone#: (full Are you an employer?Cheek the appropriate box: Type of project(required): __ : -em to full and/or part-time).* 7. ❑New construction l.�i am a employer with P Y IF]I am a sole proprietor or partnership and have no employees working for me in 8• []Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3, 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12. Plumbing repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. $ 14ther d V 5.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'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 and job site information. v ca 0 Q . Insurance Company Name: e ( j ExpirationDate: t ' f policy#or Self-ins.Lie.#: r `� Job Site Address: '" " f— �t�PA City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). on punishable by a fine up to$1,500-00 Failure to secure coverage as reags w d ase ivier l penalties in the form of STOP25A is a criminal 1WO1RK'ORDER and a fine of up to$250.00 a and/or one-year imprisonment, day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. hereby certify u dep ins ndper2allies of perjury that the information provided above is acre and correct. I do Si nature: 100 7-7 Phone#: ° LEseDonly. Do not write in this area,to be completed by city or town official. n: Permit/License#hority(circle one):Health 2.Building Department3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector Phone#: rson: AC40RQ® DATE(MMIDD/Y `r✓ CERTIFICATE OF LIABILITY INSURANCE 3/17/20155 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 policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER NAMEACT Kenia Silva Marketing Associates Insurance Agency, Inc. PHONE , (617)964-5340 FAA/C No):-(617)965-1843 150 Wells Avenue ADDRIESS:ksilva@telamonins.com INSURERS AFFORDING COVERAGE NAIC# Newton MA 02459 INSURER ANautilus Insurance Company INSURED INSURERB:COmInerCe Insurance 34754 Wilson Valdez, DBA: Master Roof INSURERC: P.O. BOX 83 INSURER D: 151 Main Street INSURERE: Milford MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER:Master 14/15 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL 8 BR POLICY EFF POLICY EXP INSRLTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE Fx_1 OCCUR 419532 /10/2015 /10/2016 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 ''.... GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRI LOC $ AUTOMOBILE LIABILITY Ea a.,de.t)_BIND - LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED X SCHEDULED BWQ71 1/29/2015 /29/2016 BODILY INJURY(Per accident) $ AUTOS AOPERTY UTOS X }t NON-OWNED (Perraccid ntDAMAGE $ HIRED AUTOS AUTOS $ Medical payments UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION 5 $ WORKERS COMPENSATION ill be issued under WC LMI OR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE D NIA seperate Cover within E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 4-48 hours ELDISEASE-EA EMPLOYE $ (Mandatory In NH) . . If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Siding Installation is subject to $500 deductible per claim.Roofing is subject to $2,500 deductible per claim. See Attached for Additional Information CERTIFICATE HOLDER CANCELLATION VendorInsurance@Lowes.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Lowe's Companies, Inc. and any and all subsidiaries AUTHORIZED REPRESENTATIVE Attn: Vendor Insurance P.O. Box 1111 N. Wilkesboro NC 28656-0001 Wilkesboro, Michael Susco/FPIT C---� ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 pninnt m Tho Ar-r1Rr1 nnmo and Innn nro ronictororl mnrirc of ACr1Rr1 r Massachusetts -Department of Public Safety Board of Building Pegulations and Standards �OilStZACiIOi� aii�iFi i iSi1' License: CS-102403 WILSON R VAI*Z �, 151 MAIN STREET MILFORD MA 671757 i � w il"' Expiration Commissioner 11/20/2016 I ��e�poau��aa�tcueallf a�P/j!�«e.reic�cc eCl Office of Consumer Affairs'&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 150577 Type: xpiration: 4/11/2016 DBA MASTERROOF WILSON VALDEZ 151 MAIN ST g� ,� - a MILFORD,MA 01757 Undersecretary