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HomeMy WebLinkAboutBuilding Permit # 9/30/2015 BUILDING PERMIT �aoRTH O&.fit TOWN OF NORTH ANDOVER �� 46 ® APPLICATION FOR PLAN EXAMINATION ' I �14 coc�i�n•.m4� ''... Permit No##: Date Received A�RATEn`�p"y cy gSSACHU`S Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION ; J®Z I 5a�M J4 Print PROPERTY OWNER �,r� - Print 1 o0 Year Structure yes no MAP,I PARCEL: ZONING DISTRICT: Historic District yes I n f Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family [IAddition 11Two or more family [I Industrial ❑ Iteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other pYY 3A-F4-W-M-0-4-i'000r Y ,r ® ,. e District Y , DESCRIPTION OF WORK TO BE PERFORMED: U henUficat' - Pleasg Type or Print Clearly OWNER: Name: C6-6 7u5�` vel'N Phone: Address: 12- Ito 0-. t '1 Contractor Name: A(416 Phone: �7� �7r74 Email Address Supervisor's Construction License: a Exp. Date: Home Improvement License: Exp. Date: ARCH ITECT/ENGINEER_ I4 Phone: Address: Reg. No. FEE SCHEDULE.BULDING PMIT.$92,00 PER$1000.00 OF THE TOTAL ESTIMATED ST BASED ON$925.00 PER S.F. 1 Total Project Cost: $ V -1 �� FEE: $ 13 � i Check No.: 9�O 5 9b �2 q 2� Receipt No.: ctin with unregistered contractors do not have access t uaran Ind NOTE: Persons contra g g t I I NORTH own oT .. 117,, ndover o qbz.. z o - ' ver, Mass, a , A- COGHICHlWKK 7d A04ATEO Ally? S 7S U BOARD OF HEALTH Food/Kitchen PER I LD Septic System THIS CERTIFIES THAT „ , �d, ,,10, BUILDING INSPECTOR . .. .. .. .... ... .0. ... owf!14 Foundation, has permission to erect .......................... buildings on YYYY4.�.... .. f.��... . .... ♦ Rough . . .. to be occupied as .. .... ... . ........ . ............................................ 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 N HELECTRICAL'INSPECTOR UNLESS CONSTRUCT , 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 Dr Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 8010290169 FIR Donnelley 02013.All rights reserved. 0667 CONTRACT# U LJ'U MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LOWE'S AUTHORIZED REPRESENTATIV� = CUSTOMER, NUMBER STORE NO. STREET ADDRESS STREET ADDRESS W P1 CITY, STATE ZIP CITY STATE ZIP WY42J TELEPHONE TELEPHONE ,v =E CHARGE ,/ TERS LLG'S MA HIC NO.: 148688 CASHF_CARD F REG FEIN:56-0748358 This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon payment,the entire agreement,including the specifically completed pages of this document,the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contract." PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS CITY STATE ZIP C -7 se f ......... 4", t 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 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 Contract 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. Contract Total ' AYes ] No *applicable tax included Are permits required for this installation?: �11,1�11111:, NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet 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. I Ill be given a quote and a change order Napply.If rotted wood is discovered during installation additional charges will pp Y.YOU w must be completed and signed by the customer for any additional charges. _Customer must initial. *Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors 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 all right,title and 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,publicity,illustration,training and Web content. By initialing here, Customer agrees to the foregoing.- [Customer to initial to the left]. Work is to commen6eypon reasonable availability of Contractor and/or any special order omer made Good(s)which is anticipated to be ,,,Zo us omer made Goods) Ifil [fill in date]. Estimated completion date Is [fill in date]. Said estimated substantial completion date is not of ha essence. A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable, insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must By in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000,00: ]Customer to Pay in Full; OR [ ]Customer to use the flowing payment schedule: (1)Deposit $ to be paid upon signing fact. Deposit should be 1/3 the total contract price;and (2)Payment of $ to be paid anytime after is Contract is signed and before commencement of installation,l[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 time after the date this Contract is signed;and Deposit mylour check for the amount of the payment indicated above any (3) Final payment of$100.00 to be paid upon completion of the Installation and both parties'satisfaction. -N I A d'.13=011=10T Pr P r.1 AIMS COVERED BY,MaA__c_-1_4_2A This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon payment,the entire agreement,Including the specifically completed pages of this docuT,,nt,the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contract" - PLEASE READ ALL TERMS AND CONDITIONS 014 THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING, INSTALLATION STREET ADDRESS CITY '-------� STpATE ZIP „ar�o�� �x e�,,, r"dnd'��wdiµr�°""r✓>". �..�yi .o�. �,�,�I "�"P�"`'t',"". r ' e k t f p fl J 7 f ^p a n a e,t,.:.m '�sF�` d�^" sr inn G �di eQ 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 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 Contract 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. Contract Total Are permits required for this installation?: ] Yes No *a applicable tax o C l NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet 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 must be completed and signed by the customer for any additional charges. Customer must initial. *Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors 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 all right,title and 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, publicity, illustration,training and Web content. By initialing here, Customer agrees to the fore oing. [Customer to initial to the left]. Work is to co en4e upon reasonable availability of Contractor and/or any special order o"cusomer made Good(s)which is anticipated to be Z i �`r'5Z " [fill in date]. Estimated completion date Is —[fill in date]. Said estimated substantial completion date is not of�he essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable, insert a statement of such contingencies). 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: M'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,]/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, NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M G L c.142 LOWE'S AND OWNER HEREBY MUTUALL AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCK P(SPUTE T A PRIVATE ARBITRATION SERVICE WHICH HASBEE APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE"OF O tNSUMER FFAIRS D BUSINESS REGULATIONS AND THE OWNER SMALL E REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PRov16ED ll`"M G L c.1e42� e By „f.. fir ,r Date: Lowe's' enters L� All By: �! Date: Owner Signature �4, 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 SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BUNK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE,FOLLOWING PAGES OF THIS CONTRACT. Y SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,YLINDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REV r ARSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. YOU ARE ENTITLED TO A COPY O T IS CONT C T*T THE TIME OF SIGNATURE. WITNESS OUR HAND(S) AL ND S SBELOW THIS " - ( PAY OF Lowe's Howie"Cert rs, LLC,/ i r Lowe's Authorized Re ren , 'Ive Owner ' '"^""'' �' Ca owner or Witness Customer acknowledges receipt of a true copy of this contract which was completely filled In prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. 55102 REV. 12/13 Fit...E COPY © ooa by Lowe'sLowes and the g design are registered trademarks of LF Corporation. i c Inc UUMMunweuun u/ Department of Industrial Ae', idents Office of]investigations .l Congress Street, Suite �00 V Boston, MA 02114-2017 www n:ass.gov/dia Workers' Compensation Insurance Affidavit: Builders/lGontractors/Electricians/Plumbers Applicant Information M (,, I Please Print Le ib1 Name (Business/Organization/liidividual): /YtIChQeI ! tt�tC Address: - i City/State/Zip: (} 0 t97 o phone 636-717Y Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4• ❑ 1 am a general contractoil and 1 * have hired the sub-contrIctors 6. New construction employees (full and/or part-time). I 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors h ve ship and have no employees 8. ❑ Demolition working for me in any capacity. employees and have wor ers' q ❑ Building addition [No workers' comp'. insurance comp. insurance. required.] 5. [:] We are a corporation an its 10.❑ Electrical repairs or additions 3.F1 I am a homeowner doing all work officers have exercised t I eir i 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per NGL 12 ❑ Roof repairs insurance required.] t c. 152, §1(4),and we ha�fe no employees. [No workers 13.❑ Other comp, insurance required.] Any applicant that checks box#I must also fill out the section,below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outzide�contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-cxmtractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.poli y number. I am an employer that is providing workers'compensation insurance fur inemployees. Below is the policy and job site information. Insurance Company Name: j Policy#or Self-ins. Lic. #' f_ Expiration Date: f 216 5a ktb I Job Site Address: City/State/Zip: a. .Attach a copy of the workers' compensation policy declaration page(sho�ving the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 cani lead to the imposition of criminal penalties of a tine tip 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 Be advised that a copy of this statement may be fotwyarded to the Office of of up to $250.00 a day against the violator. Investigations of the DIA for insurance coverage verification. I do hereby certify un er t e pqins and enaldes v er'u that the in ornt ion provided above is true and correct. Signature: Date Phone#:--.'77S—�3 '7� Official Ilse only. Do not write in this area,to be completed by city or town official. 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 6. Other Contart Per-,an- Phn�le#r CERTIFICATE OF LIABILITY INSURANCE � � ry I HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS i CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 1pri �S ; !BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUtHORItEts 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,sub]ectto" 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). -PODUCER CONTACT Patricia Guercio Parente Insurance Agency Inc. PHONE : Fax 94 Lynn Street E nsalie,Ext): 978-531-8854 — ---- .(A/C,No): 978-531_r�587 Peabody MA 01960 ADDREss: parenteinsurance@gmaii.com - INSURER(S)AFFORDING COVERAGE_ INSURERA:Atlantic Casuity Ins Co ssD Mike Demille INSURERS: S Bristol Street INSURER C: Salem MA 01970-5411 INSURER D; INSURER E: --- INSURER F: OVERAGES CERTIFICATE NUMBER: 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 NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CL-RTIFICATE 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- _ - -;�g -- IADD I POLICY EFF ; POLICY EXP Fz TYPE OF INSURANCE I POLICY NUMBER MMIDD MM/00 LIMITS COMMERCIAL GENERAL LIABILITY ! ,� j ! EACH OCCURRENCE S 300,000 t" 'r�` DA AGE TO RE TED CLAIMS-MADE OCCUR PREMISES fEa occurrence, S 50,080 L118000742-3 08/29/201510812912016 MED EXP(Any one person, 5 5e000 '.. PERSONAL&ADY INJURY g 300,000 -------- - -- ; '- � a 500,000 ?.Gr.RCG-',TE C69i T sPPLIES PER I GENERAL AGGREGATE ..___ I J 3L!C i 1 J JECT F LOC PRODUCT_S-COMP/OP AGG I S 300,000 -- — COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident} $ rBODILY INJURY(Per person) S A_ 0 NEG SCHEDULED 'BODILY INJURY(Per accidenAUTOS t) S 1NO-OIANEO j PROPERTY DAMAGE S j :r1IFtD .UTvS AUTOS (Peraccidentl �iMBRELLA LIAB OCCUR ( EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE: j AGGREGATE_ S I - P.ETENTtON 5 + S I 411ORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY ' STATUTE_ YIN' 7 iiOEREiOP,/PA.P,TNEP./EXEC'JTI`✓E - i' E.L.EACH ACCIDENT is �FFn ERIMEIABER EXCLUDED. :NIA Rlandatory In NH) LE.L DISEASE-EA EMPLOYEE 5 _ :f des descr.re under € DESCRIPTION 0=OPFRATiaNS below E.L.DISEASE-POLICY LIMIT ' S i I ago DESCRiPTiON OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 10i,Additional Remarks Schedule,may be attached if more space is required) I 1 CERTIFICATE HOLDER CANCELLATION Lowe's Companies, Inc and any and all subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Vendor Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PJ Eox 111i ACCORDANCE WITH THE POLICY PROVISIONS. N Wilkesboro, NC 28656 AUTHORIZED REPRESENTATIVE t I ©1988-2014 ACORD CORPORATION. All rights reserved. ArGORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web software,www-FormsBoss.com;O Impressive Publishing 800.208-1977 r, I Tx yo 9 Office of ConsumerAffai rs and Business Regulation t 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 h f; Home Improvement Contractor Registration ' Registration. 162722 E; Type: Individual MfCHAEL THOMAS DEM ILLE Expiration: 416x2017 Tr# 264520 WCHAEL DEMILLE 5 BRISTOL ST SALEM, MA 01970 --- __ -- scA s 6 2(j16t-Qs,t j Update Address and retarn card.Alark reason for change. Address Renewal ❑ Employment ❑ ost Card 17t3lLOlt!/EY7FE� .�✓![lrJJrlr��Jc�1.f fricc of Consumer Affairs&BasiQess Reg,)aliou License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date, tf found return to: egistration. 762722 Oration: 416!2017 Type: Office of Consumer Affairs and$usiness Regulation individual 10 Park Plaza-Suite 5170 "'-----`- - MICHAEL-THOMAS.OEMIL=L-E Boston,MA02It6 ym ! 5 BRJSTOL ST ALEM Not valid wathoutsignature ti Smamd of am Sol" k \ \ \ \