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HomeMy WebLinkAboutBuilding Permit # 10/15/2015 00RTH BUILDING PERMIT ®��4,eo �4�+ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ® ' ' a / mh Permit No#: ` Date Received orrD " ��ssgcaau5���� Date Issued: Z6—( -t 1 IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER l 1 Print 100 Year Structure yes o MAP PARCEL: —.--%/ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other mr, r a erS ➢ , � �, � � %r, r > > 1 i! !� i r,�,r ,r., i�l DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please pe or Print Clearly OWNER: Name: �( . Q 30 . a� Phone: 73-1 Address: t Contractor Name: X11 " �� rPhone l " Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED ST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ � L)61 o 0 )- .. Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund f,,ori o, i FORTH Town of a _E. ...'.p, nclover 496 No. oo-7A _ o"- ,. h ��I'' SSS' COCNICN'WICK y1' S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT V.14AAe..... . .4. ................................................ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .....ii........... ,r+1vl... ...... .. ........... .......... Rough 12 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS Rough Service ................. . .... ... ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy RuildinRough 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. 8010290169 RR Donnelley02013.All rights reserved.-0667 *+ r CONTRACT# V aooa �� - UK � _ ,� ',tr... z3y x ��:�r��c��,��.»-'"''-�..,,..�" .� .' fi'�,a����" �'�`��r�"��,¢' gin' �1r■y j 1 ,F k^ d C LOWES AUTHORIZED REPRESENT TIVE NUMBER CUSTOMER r2 471 �thc. Gt-'Z�K , , STORE NO.t RJEEST ADDRESS RESSSTREETADDJR ADDRESS CITY STATE ZIP CITY � STATE ZIP ,r r R✓ r O/9irC/o tr r � TELEPHONE7P 1910�F2 13 21f- 1314 49 ., �.. TELEPHONE j DATE LOWS S HOME CENTERS LLC'S MA HIC NO.. 148688 CASH K LCC REc cAR FEIN 56-0748358k � o '$' CRAK=E �)bfi`iS,'Opl.a ffi'ro1•t4g��andis�`�13iw,se(tn'x"`� `t�it"bsto�+Y�� �;=r "�`�. '_: � ;7?.x r , �„��t:� � i MINN �Hbtxi�enf ire ani n5t>1fa�� � all�° �, � D`��r�� "nR���1��` s�� ➢7el`ed pages.o'f tfils PtiSSE�i7QCQ �S �z. BEp� �E 1Eut r s .n INSTALLATION STREET ADDRESS CITY STATE ZIP Gdyr Y G le /e r /V Cr ds ua �� a r 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 *applicable tax included 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 foregoing. [Customer to initial to the left]. Work is to comynenceJupon reasonable availability of Contractor and/or any special order or g er made Goods)which is anticipated to be AQ 3011 r [fill in date].Estimated completion date is_�/ f-> d [fill in date]. Said estimated substantial completion date is npt n. of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: /i r✓— (if applicable, insert a statement of such contingencies). IF THE CONTRACT TOTALIS$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: (I)-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,I/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.142A � f' LfL T G l`z"�i� � t"' Ct.. ��e7• �. Y e:� ,r'i.I Kl � i C � �� i 1 1l �t-4 i i 7e�r, 5 ted�'•" ,t t'!<L��..+ L.z �.�e- `� +^S 9i ver; ✓�r� �--^es j �i�t�D��l ;.•�lau'`��i,1.�3 � 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. tom/ Contract Total Are permits required for this installation?: Yes [ ] No *applicable tax included 40 ///8 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 foregoing. [Customer to initial to the left]. Work is to com encf upon reasonable availability of Contractor and/or any special order or�ust er made Good(s)which is anticipated to be !U 30' [fill in date].Estimated completion date is__ %1//.> tr1 [fill in date]. Said estimated substantial completion date is npt of the 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: [A Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (I)-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,I/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.142A LOWE'S AND OWNER HEREBY MUT LY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPY E70 A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSt1�AFF IR AND BUSINESS REGULATIONS AND THE OWNER SI j�LREQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDES LvL.cam, By. Date: Low Is Zie / By: Date: ��/ 3 5 Owner Sidin5ture 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. 7SIGNING GN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND S CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE D CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS .YOU ARI-ENTITLED TO A COPY OF THIS CONTRACT AT.THE TIME OF SIGNATURE. WITNESS OUR HAND(Sy-AND AL(S)BELOW THIS -.. '*�? DAY OF .r i1�r.-t>Ij Lowq's Home Gd9 rs - ' C Lowe's Authorized Re "sgnt tiv�e— Owner '' Customer acknowledges receipt of a true copy of this contness ract which was completely filled in prior to Customer's execuor Co-ow ar ri nichereof.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 FILE COPY ©2004 by Lowe's.®Lowe's and the gable design are registered trademarks of LF Corporation. G The Commonwealth of Massachusetts Departntettt of Indrlstrial Accidents 0 --ce of Investigations 600 Washington Street r Boston MA 02111 WWif.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/F,lectricians/Pluinbers Applicant Information Please Print Lmibiv Name(Business/Organization/Individual): Address: 1-7 C—iv>>.._ • City/State/Zip: �°V�► _LYl ©2t S( Phone#: Are you an employer?Check the appropriate box: Type of project(required): I.� 1 am a with employer 4• F1I am a general contractor and I. ,� G. ❑New construction employees(titll and/or part-time).* have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have S. 0 Demolition working for me in any capacity, employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp, insurance.+ required.] 5. [] Weare a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their I I.0 Plumbing repairs or additions myself. fNo workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]z c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp. insurance required.] 'Any applicant that checks box of 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 contmetors 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. 1 ant an employer that is providing workers'compensation insurance for my enThi yeem Below is the policy and job site information. Insurance Company Name: Policy It or Self-ins.Lie.#: �2w 0:5 q 71 Expiration Date: -------_- Job Site Address: - 1`JV�r&n City/State/Zip: _. or V/_tnM�k- 14a� � 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 penalties of a fine up 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 of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify ttnder_theearns and penalties f p�tjunr that the i»forn ation provided above is tare and correct .,% 7 -,. S. Date: Phone;I ` Of use only. Do not write in this area,to be completed by city or town of 1.111. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone#: HPk_II_i-201' 11:08 From: j:®11 80J825 V/ I LI I.4/ r a t u),J O Airl CERTIFICATE_ LIABILITY INSURANCE E1:1A �di— THIS CEf2TIFII;IITE I3 NSS OissT D AS A MATTER OF INFORMATION ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE HOLUn- •I•Hi$ CERTIFICATE OCE$ hiOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORD&D BY THE POLICIES BELOW. THIS CERTIFFCATt: OF INSURANCE DOES NOT CONSTITUTE A GONTR/lt;T BETIIVEEN THE ISSUING IN iURGR(S), AUTHORISE) REPRE3ENTq'fIVE 012 PRODUIrER,AND THf?CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an AADITIONAL(N$URED,ttt6 pp(tCy(igs)nulst Vs andorsed. If Sllt3tiol;IA714N IS WAIVEp,lsubje0t tD ", 'S and conditions of the policy,certain r certiftaaka holder In Abu of such endorsement{sj�II�i��may auir�an ndorsameltt. A statement an(his Qertific�tp loos not confer rlghts to the PRODUCER JaEu't F gi io E, Maty Al% SOhrut_Ea ggio xnsusanc� rg�hGy nE, 399 Wsnhpp StrPpt (611)$46-8600 TAirlt h�>�p, MA 025 52At ymb29)Iiggia3a18ur2tSlC0,Cogs A t a lc27)QJ6"-Bg«9 --•— IN5URE:R AFPOttc CW`JERAGI: INsvRua uRMA:Hgr1 rvi11s-- I"ns"anQa -Com v _ $il.ip .7 it�±rrLfscahio, �ZI w, PERUace O---- 17 - a17 Cli£zorx Ctra-j!!t NJSUR c: — Revara, MA 02151 T I"011 D; IN&DRERE: .. CUVERA(i-,I_5NSURERF I GER'TIFICATE NttMBEF2:CL14�y00826 THIS i5 TU t:tRTiE"Y`CHAT THE ppLIGIES OF ItJSLt REVISION NUMBER: N-DJCATEC), NOTWITHSTANf)ING:ANY F �tUIP,EhtFNT,ITE U TED BELOW HAVE BEEN ISSUEp 7D THE►N°,UFtEQ NAME4 AB{)VE FOR T1iH AULIC Y PERIOD OERTIPIGATE MAY 13E ISSUED OR tdAY PE OR CONDITION OF ANY CON RACt OR OT14EF�17UCtSM14EA(r WrTld RESPECT TO VIHICH THIS UX+✓LUS10N5 AND fiTAIN, Trip INS ONCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I9 SUBJECT TO ALL THE TERDAS, CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVe WiEN REDUCED BY PAID CLAIMS, TR TYPE CF I-,---NCs I POI. YNUuDo POu OFK PlIL.I GENERAL LCABIIlrY _ t7 L1MR3 COV:tERCIALGUZAALLIABI lIi' Ei1irHOGCUPJiLNCE g 1,OOb,000 DAPS ttT�`[='t� A CLAI'/8•V.ADEnx OCGUfi t Ft�t!I3 1001000 88 K096,L� 2/15/2014 12/1512016 —" MEOEXP(Any e.96ner. ,,, . 3,00G PERSONAL a ADV INJURY $ 2 r Ann 000 0=N'LACGRERATcLIMIT APPLIES PJ5R: GENERAI..43GPECATE 2,000,000 POLICY X r'Fa Ipc FRObuffs-C:0Mr-,'OPAGG s 2,000,000 AUTQUonjLEf ABILtn• 3 'I1 INLiLE LItLIT A ANYAUTO ` AL(,QpVrNED "CHEr�JLED EL7DILYIYIURY(Perpo�c{I) S T00.000 ALROS ALROS DOO(10074a79m 6/18/2014 )8/16/2018 LILY INJLIrcY(PV ACc t¢r(} $ HJItfiDA(rTQq St NON•ovaJJ� 00 000 AUTO$ PR RRTYDrSk G JPS 4 100 000 UMBRELL4LIA8 _ OCCUR EXCESS UAQ a`LAIW4AADS CACHOCCURRcuC $ �' DE R- 'JONS $ :YDRJlF.R490MPENSATI0N a AtJt1f=.NPIWYCREMIAMLITY x INC=AT4. OTH• y ANY FROPFIE70MPAKTNER1j{fE urisF Y _ .¢Z ,4i i(INaltK4to1intt8�J F:XCLUDED7 NIA , EL EACHA=IDEW -k 'too 000, 1 y& 'ryItoLIMIer W4Ei8572U 1/3/2015 1/3/2015 --, -- Dl:S r?ir*nctJORCPERATIU, b5(;µ in.i..OI$6%SE--AR1Ipwy 1.00 OGG /3/201$ /3/2016 E•LDJSEA$E-POLCYUlItT S DESCRIPTION OF OFCIRA7I0*'5)LOCAllonsI VpUIC LES(A('eh ACORD 101.Addlk)nM Remertcn 0eh6CU16,R mora opee0la rgqulrclj Vendor #24305 Lowe-in c mpanios, LIG. and ally and all bubsi.dA.trieF are named additjohal ins=a(A oe respsat to t'r.n�za? and put omooilo �dsbiJ iffy CER FICATE HOLDER CANCELLATION (781)480-3825 SHOULD ANY OF Ttig A13OVE DESCRIBEO FOLIGIES BE CANOL:1,4L`R BEFORE THE EXPIRATI)N DATE THEFT OF, NOTICE WILL BE DFLN/EREn IN LQot41>3 Gampslni ems, r te, and alb. and all ACCORDANCE WITH THE POLICY PROVIr$ICNS. subsidiaries P.O. Box AUTH6fl12C4 urPAFSEHTATP4 N. WxlkesbCYo, bIC 28656 A-fton St. Revere,, M-A 02151 SCA 40 20 coy� BMW 1.2 v \\ \ \ \\\ \\� 4h, Board of BLdiding Regulattons and Standards Licert : CS-072573 , db, PHILLIP 3`V"RRNAC 17 CLIFTON ST Revere MA 0215T' ,P r� -- a� a�� Exp4afion ar�reirau �nr 04/27/2018