HomeMy WebLinkAboutREMOVE AND REPLACE 1 BACK DOOR %AORTII
BUILDING PERMIT 0 TLF D 0 6
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received ATEP npp R5
C
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
1,int
PROPERTY OWNER ogaeoos
2F, W Print 100 Year Structure yes rio
0
O� G
MAP ,- PARCEL:-� N DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
11 New Building ne family
ri Addition El Two or more family 11 Industrial
El Alteration No. of units: El Commercial
epair, replacement 0 Assessory Bldg El Others:
Demolition [I Other
fl,�,'Jbbd �,",W 11;,,�5111111fllw
DESCRIPTION OF WORK TO BE PERFORMED:
Woo vt/ rtf(a(,L U e-4�ktl �)OLzA
Id tifieption- Please Type or Print Clearly
OWNER: Name: Num vneA 4-f&.5 Phone: o .
Address: S APOI-�b"60,01'
Contractor Name: )05Cf� Mc-ma-ty Phone: 1-79--7dq - 6 593
Email:
Address: :76 :7 D-d6fn Si, 11AVhthqLa* rhh OW7--
Supervisor's Construction License: 8 1 q 7Lt —Exp. Date:
Home Improvement License: 1 -77 5(,7 Exp. Date: to
ARCHITECT/ENGINEER Phone:
Address: Al A Reg. No.
V I W
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED C T BASED ON$125.00 PER S.F.
Total Project Cost: $ I04 FEE: $
Check No.: o.5-7 q 6 e !2aq7J Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
ig/7I92�
FORTH
Z E Town of
..II'
dover
0%
o LAKE h ver, Mass,
COCHIC"EWICK
p0OATED ►P��s(�
S U
BOARD OF HEALTH
Food/Kitchen
PERM T T Septic System
THIS CERTIFIES THAT ........� BUILDING INSPECTOR
. Foundation
has permission to erect ............... .. buildings on .. ..® .......� �.t:1..� `!`:�'-�...............
, ,,��// �� Rough
to be occupied as ......... .4�L�,�...... ......4p .............................................................................. 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
a
PERMIT EXPIRES I MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIOS 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.
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
__MliSALEM, NH 03079-4499 SALESPERSON ID:631180
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 KEVIN MEDEIROS 9 - 01
O Customer Address Other Phone
108 KINGSTON ST 774-263-6063
L City State/Province Zip/Postal Co
D NORTH ANDOVER MA
Installation Address
T 108 KINGSTON ST
O Installation City Installation State/Province Installation Zip/Postal Code
NORTH ANDOVER MA 01845
MERCHANDISE AND INSTALLATION SUMMARY
MERCHANDISE SUMMARY
26638 : PRODUCTCODE : SOS : SOS TRISYS 3/4 OVAL FRAME - DF : ARCHITECTURAL DOOR GLASS FRAME (***15% OFF RETAIL ON ALL SPECIAL
ORDER ENTRY DOORS***) : DOOR FABRICATION SERVICES INC - QTY 1
326798 : PRODUCTCODE : SOS : SOS RB PNT/PNT DECO SM FG TC DFAB : ENTRY/EXTERIOR SINGLE UNIT, HAMPTON 3/4 OVAL***15%OFF RE-
TAIL ON ALL SPECIAL ORDER ENTRY DOORS FROM 07/01/15 THROUGH 07/14/15*** : DOOR FABRICATION SERVICES INC -QTY 1
111088 : 31570FJPMD : STK : PFJ CASE 315 2-1/2 X 11/16 X 7' : PFJ CASE 315 2-1/2 X 11/16 X 7' : EMPIRE COMPANY, INC. (THE) -QTY 3
209633 : 02599 : STK : PVC SHINGLE MOULD 8-FT : PVC SHINGLE MOULD 8-FT: EAST COAST MILLWORK DISTRIBUTI - 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 3
585250 : 20297817 : STK : LARSON QUICKFIT HDL KIT BN : LARSON QUICKFIT HDL KIT BN : LARSON MANUFACTURING COMPANY - QTY 1
Store 2382 Project No. 446903720 for KEVIN MEDEIROS Page 1 of 8
STORE COPY
585279: 14606031 : STK : LARSON TWMV 321N FRAME WHT : LARSON TWMV 321N FRAME WHT : LARSON MANUFACTURING COMPANY - QTY 1
Materials Price $ 1113.97
INSTALLATION DESCRIPTION
Stock or SOS : SOS Door Type : Exterior
Select Location : Back Door Select New Door : Single Pre-hung
Number of Doors to Install : 1 Side Lights or Transoms : No
Hardwood (Mahogany or Oak) Door : No Hidden Damage Description : None
Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No
Install Storm Door: Install new storm door Select Storm Door: Storm Door
Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 24
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 : None Comments : see m20
Labor Charges $ 572.00
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
Store 2382 Project No. 446903720 for KEVIN MEDEIROS Page 2 of 8
STORE COPY
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 Servic r rf rm
TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES *where applicable
SUB-TOTAL $1650.9
*TAX $ 0.0
DELIVERY $ 0.0
ORDER TOTAL $ 1650.9
BALANCE DUE y
Work is to commence upon reasonable vailab ontractor which is anticipated to be / [fill in date].
t
Estimated completion date is [fill in date].
NOTICE TO CUSTOMER
All itemINTRiAICT
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 orm. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation
necessiefective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom-
er.
IF THE TOTAL IS$1,000.00 OR LESS Customer must pay in full.
C MP ATE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
[_] stomer to Pay in Full; OR
[_] Customer to use the following payment schedule:
(1) Deposit of$ 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
Store 2382 Project No. 446903720 for KEVIN MEDEIROS Page 3 of 8
STORE COPY
(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 .
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.1 42A.
BY: Date:
Lowe's Home Centers, LLC
BY: 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 BEPERMITTED TO INITI ALTERNATIVE DISPUTE RESOLUTION
EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE 914TIES.
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS DAY OF
Lowe's Home Centers, LLC
BY: (S a!)_,
Print Name:
(Seal)
Store 2382 Project No. 446903720 for KEVIN MEDEIROS Page 4 of 8
7 r STORE COPY
Address OW
r
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. 446903720 for KEVIN MEDEIROS Page 5 of 8
The Commonwealth of Massachusetts
_ Department of Industrial Accidents
Office of Investigations
t � r ;; 600 Washington Street
Boston, YYIA 02111
F tvtvw,n ass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeWbly
s\talllle {F3usincss/Orgunizanionlloclividual); �JO�p� ���Clll/
Address:_ 7 I WQ6iw
City/State/Zip: t i'1 0 Phone#:
Are you an employer?Check the propriate box: Type of project(required):
YI am a employer with —1-- 4• [-] I am ageneral contractor and 1
elliployces lull and/or part-finle ..; have hired the sub-rontraetot� Naw construction
'.❑ I am a sole proprietor or partner listen on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 9' ❑ Demolition
working for me in an capacity. employees and have workers'
pa 9. ❑ Building addition
[No workers' comp. insurance comp. insurance
5. �1je acre a corporation and its 10.❑ Electrical repairs or additions
required.] ❑ P
3.❑ 1 am a homeowner doing all work officers have exercised their ILEI Plumbing repairs or additions
myself. (No workers' comp. right of exemption per iVIGL 12.❑ Roof repairs
insurance required.I c. 152. §1(4).and we have no
employees. [No workers' 13Other_Zknor 2 _r
comp.insurance required.] V.
'Any applicant than checks hox P I nnlst ako fill out(tic section beh�w showing their workers'conplensation policy information.
IfontcowDef s who submit this aflidavit indicating Utey arc doing,all work and then hire outside conct
traormt
s usubmit a new;fitidavit indicating such.
Comractnrs that cher k this box must attached an additional,heel shotvin;the name of the sub-contractors and slate whether or 11411]hose entities hair
cmployces. If the sub-contractors have entployec•s.they must pmvidc their workers'comp,policy numlx.r.
am an employer that is providhkg workers'compensation insurance for try eurpinpees. Below is the policy and job site
in f urination.
Insurance Company Name:_'T• �,- 11 Q� �Yl� � ►'1 tL°S
Policy It or Self-ins. Lir. t{: _t CC 50D 01'4 00 'Rol%41+ Expiration Date: 1 I Is �-
.lob Site Address:_ _ 1`l§S46e) 51 . _City/Statc/Zip:_ N164 ' OV'Q� MA a 18(is
Attach a copy of the workers'compensation policy declaration page(showing the police number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 cern lead to the imposition of criminal penalties of a
line up to S 1.500.00 and/or one-year imprisonment.as well as civil penalties in the form of it STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that it copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I du hereby cern' fader the pains and penalties of perjury that the utfin nratintt provided above is frac and correct.
,Sit,flat tire: r Date:
Phone It: Q Za�-��oZ
(7.ricial 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):
I. Board of Health 2.Building Department .i.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person:- ------ -___-- Phone ____--
Inn rrnL n Ir�oursnlyl,t ra ftrr4DyCb1 Alir 1 LUIh b:'2L P. 0
9MCNA01 OP ID:DP
CERTIFICATE OF LIABILITY INSURANCE
DATE 016
04J01J2015
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 terns and conditions of the policy,certain Policies mey require an endorsement. A statement on this cortifleato doers not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER NAME: David C BrUett
John J Walsh Ins Agency,inc
P o box 4407 PyD HONE Nn E.:978-745-3300 F, Nol;978-74s-9557
Salem,MA 01970.6407 =-
David C Bruett ADDREbs:dbruett@waishinsurance.com
INSURER(S) AFFORDING COVERAQE INAIC tt
W&URER A;Travelers `
IitsuREo oseapry h McNatruction LVsuRERe.A.I.M.Mutual ins.Companies
7671 oburn Street INSURERC:
Wilmington,MA 01887 INSURER D:
INSURER.r: �V
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIBS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THF POLICY PERIOD
INDICATED, NOi ATHSTANDING 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,
OCCLUSIONS AND CONDITIONS OF SUCH POLICIES,LiMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�I— TYPE OF INSURANCEV POLICY EFF -
.I POLICY NUMBER IAA!! I LIMITS
i oENErtaL W161LITY !
EAC44OC'/;URRENCE s 1,000,000
A ;C;Id_fiCAr_GENERAL_IAwIL1TY 680-6621P22A-16-42 021081201$ 02108120161 p sE�tEemrxnaxt s 300,00
CLAWS-MADE ;OCCUR ! 8i0 61EOEXP Ar d>" )
XXBBusiness Owners _ n Pecan 0
PERSONAL 8 ADV INJURY Is 1,000,000
ENERAL 1,00SE LATE 3 2:000,000
GEMLAGGREGATEUMITAPP�LIE75PER:
PR'O- I rPRODUCTS-COMPIOPAUG S 2,000,00
POLICY I Ll'�C ..
AUTOMOBILE LIAAKJrr
-
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AUTOAUTOS6pC(Y INJURY(Pbt 5tctiTi)
41OATOS NON-OANED
AUTOROA -
9
(PER ACCIXN7i S
"_. UMBRELLA LUID I+ S
OCCUR EACH OCCURRENCE S
EXCESS L1AG CLAIMSMADEI
AGGREGATE 4
,
_1 I OED I 1 RETENTIONS $
WORKERS COMPENSATION i 4 11CSTATU- 0—T H.
AND EMPLOYERS'UASILITY YIN 13Y TAT1- F
B ANYPRGPkIETC>aIPARTttERIEXEG.;iIVE WCC6005014081-2014A ;11/14/2014 111141201$ E.L,EAGHACDioeur s 800,00
OfFLy
CER,h1EMBEtik-.x,GWOED' �N)A
(fAdlldatnry in NH) EL.DISEASE-EA E1;IPLOY6 3 500 00
!f}ez,durnisc crxlcr ,
1 OEbfR�PTIONt CJPEiLITIONSootow t s G.L Sc'ASE-FOLICYL1MiT S 500,00
i PROPERTY 5,849
I
DESCRIPTION OF OPERATIONS I LOCATION51 VEHICLES(Akach ACORD i al,Addrilonill Rtftirit%Schedule,V more spar¢Is roRuiradl
Lowe'a CompaniC3, Inc and any and all subsidiaries are additional inaured
with rospoet to commercial ganoral liabiity. Waiver of subrogation applies
pew written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Lowe's Companies Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED IN
and any and all subsidiaries ACCORDANCE WITH THE POLICY PROASIONS,
Attn:Vendor Insurance
PO BOX 1111 AUTHORIZED REPRESENTATIVE
N Wilkesboro,NC 28656 David C Bruett
1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD
Massachccsetts -D(IPart flnf Of Public Safety
Buarti OF B'Jilding R@RulatdanS and Standards
(lrryct rn Nioa-Sflyerti is�tr
L'C"se: CTS-061974 Oft
.113SEPH G MCNA.AY W ��
767'WOBURN S'C
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JOSEPH 3.MCNAW ,
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JOSEPH MCNARY
767 WORURN ST
MI MINGTON,AAA 018871
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