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HomeMy WebLinkAboutREPLACE 1 PATIO DOOR BUILDING E MIT ®F t%o oT 6 quo °e TOWN F NORTH o} y APPLICATION FOR PLAN EXAMINATION Permit No#: ,( Date ReceivedArgo " R ��SSAC HUS ���5 Date Issued: ° IMPORTANT: Applicant must complete all items on this page LOCATION 105,5 sqwm Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re ' ential Non- Residential Li New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement [IAssessory Bldg 11Others: Demolitionp ❑ Other r , DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: sc, 4, Contractor Name: Phone: Email: Address: 5 `• J6(77 Supervisor's Construction License: e1q7yExp. Date: Home Improvement License: C-7- Exp. Date: e ARCHITECT/ENGINEER AlfUt Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMI $12.00 PER$9000.00 OF THE TOTAL ESTIMATED C T BASED ON$925.00 PER S.F. Total Project Cost: $ r FEE: $ Check No.: - Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t uaranty fund P l / ,, i,;%///,/,r�, /„ ✓��/%� / /��i, ,%%/%/1t�it 1T�%f��%���/�/���//�i,�/� FORTH ' A"k WH 0 .� E mak dove ' _ ., ® • — (� o ��K. h ver, ass, COCr.CH!WIC. 41' �,®ADS 1TED P?a��5 S V BOARD OF HEALTH PERMkT T LU Food/Kitchen Septic System THIS CERTIFIES THATJURABUILDING INSPECTOR Foundation has permission to erect .......................... buildings o .. ... ... . .... . .. .. ........ ......... ® Rough tobe 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 I 6 MONTHS ELECTRICAL INSPECTOR LESSS CTIO T TS 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:JOSEPH CAVALLARO SALEM, NH 03079-4499 SALESPERSON ID:897831 Document Print nate- 07/1242015 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 TYSON MOORE 781-281-8637 O Customer Address Other Phone 1055 SALEM ST L City State/Province Zip/Postal Code D NORTH ANDOVER MA 01845 Installation Address T 1055 SALEM ST O Installation City Installation State/Province Installation Zip/Postal Code NORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 6550 : 329063 : STK : 5/8"J-CHANNEL WHITE 306-WH : .625-IN X 12-FT 6-IN WHITE VINYL SIDING J-CHANNEL : BLUELINX CORPORATION - QTY 3 98458 : 07526 : STK : RML 8-FT WHITE PVC BRICK MOULDING : RML 8-FT WHITE PVC BRICK MOULDING : EAST COAST MILLWORK DISTRIBUTI - QTY 3 290270 : 290270 : STK : RB 6'PTO STL FCH HRMNY BBG-GBG RH : RB 6'PTO STL FCH HRMNY BBG-GBG RH : JELD-WEN,MILLWORK MASTERS-KNOX - QTY 1 447374: 1608LE : STK : 1 X6X8 APPEARANCE GRADE SELECT : 1 X6X8 APPEARANCE GRADE SELECT : SPARTANBURG FOREST-QTY 1 Materials Price $ 860.11 Store 2382 Project No. 447024287 for TYSON MOORE Page 1 of 8 STORE COPY INSTALLATION DESCRIPTION Stock or SOS : Stock Door Type : Patio Select Location : 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 : 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 : Yes Describe Other Work Needed ; cut back siding Other Work Charge : Yes Comments : No Comment Labor Charges $ 775.00 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. X [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- Store 2382 Project No. 447024287 for TYSON MOORE Page 2 of 8 STORE COPY 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.. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable SUB-TOTAL $ 1600.11 *TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $ 1600.11 BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be [fill in date]. Estimated completion date isJ 5 [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.An All 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): [_j Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or Store 2382 Project No. 447024287 for TYSON MOORE Page 3 of 8 STORE COPY [_] 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. 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 RBITR AS PROVIDED IN M.G.L. c.142A. BY: Date: ZW�J� Lowe's Horoe Centers LLC BY: --/moi_ Date: 7- Zv 15— 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 OUR HAND(S) AND SEAL(S) BELOW THIS DAY OF v�` ado� Lowe's Home Centers, LLC B : flits Y // (Seal) Print Name: LvC� (Seal) Address Owner �Z�( .✓ r�a��--�- � Store 2382 Project No. 447024287 for TYSON MOORE Page 4 of 8 JV1114 TrnL-Dn IrioLitimill,t r ::i/rrgbyJol Apt' 1 2UI b U:2 N. U'! 9MCNA01 OP ID:DP � . , CERTIFICATE OF LIABILITY INSURANCE °ATE(?AU.1D0fYYYY) 04101!2015 2016 04!0 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 tho terms and condltlens of tho policy,certain policies may require an endorsement. A statement on this eortUlcat©door not confer rights to the certificate holder in lieu of such ondorsoment(s). PRODUCER John J Walsh Ins Agency,Inc NAME: Qavid C Bruett P O BOX 4407 PaHrc°rN E>R:978-745-3300 FAX 978-745-9557 381em,MA 01970.8407 A C No' David C Bruett ADDRESS:dbruedQwalshinsurance.com INSURER(S)AFFORGINGiCOVERApE �_— I MAIC is INSURER A;Travelers i INSURED McNary Construction INsuRERe:A-I.M.Mutual Ins.Companies Joseph McNary — 767 Woburn Street INSURER G: _ Wilmington,MA 01887 INsuRERa; INSURER E: INSURER F COVERAGES 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 PERSOD INDICATED. NO'P10THSTANDING 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 TYPE OF INSURANCEPOUCY EFF POLICY EXP hN. POLICY NUMBER MWrW tYYI LIMITS GENERAL t�A91uTY ,EACH 0MURRENCE s 1,000,000 A Ii C0N1"=RCJA'-cENERAI_ABIUTY 680-6621P22A•16-42 02/08/2015 02108/2016 I F"PEMiLE�v(Ea ooarrarrat I s 300,00 ~�?CLAI!AS•MADE OCtYJR ----•- ri MED EXP1AnyCoe peron) ': -.--_. S,QO (((XX Business Owners i PERSONAL&ADVINJURY s 1,000,000 crNER-L Ar*REpATE 3- 2,000,000 GEN'L AGGREGATE LII�tITAP''PLI�E$PER: {III PRODUCTS_COriPKJP Ar3(3 S 2,000,00 POLICY PRD- ! I LOC j ,S AUTOMORILELIABKJTY COMa!NEDSI 1 �(Ea acedeml 1 5 } +'ANY AUTO I 5001 LY INJURY(Perpvrwwo 1s ALL b5M AUTOS AUTOS E0 j SCHEDULED BGGI.Y!wURY(Per"xc4em)�s —'NON•O'ANEO 41Rfib AUTO$ AUTO$ ACCIDENT`AUE S i UMBRELLA LIAR OCCUR --- -- I EACH CCA URRENCE S EXCESS UAn _ C;_;,IMSMADE AC-GREGATE S ! DEO � �RETENTIONS � S WORKERSCOMAENSATION -.. LIC STAT TM• f AND EMPLOYER5 LIABILITY Y/tt ; r 1175 B ANY PRCPA'IeTOR/PARTNER/EXEG�TIVE WCC6005014081-2014A 11114/2071111412016Et.EpONACCiDEN7 3 600,Q0I OFFtCrPJMEMeERFXGWDED7 �jNIA(IAandetory in kH) EL DISEASE-EA EMPLOYE 5 500,00 If)es.dr_scnbe r.T)d4i t 0eKRtPTI0N OF OPERATIONS batox # 1 E.l.0.'SEASE-POLICY LIMIT 5 500,00 1PROPERTY 5.849 DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEHICLES(Attach ACORC 101,AddrCoRpl Ror118rtte Schedule,U more spar¢IL roquiNd) Lowe's CompaniCz, Inc and any and all subsidiaries arpn additional insured with rospoot to commercial gon"al liabiity. Wa-ivar of subrogation applies POT 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 HE DELIVERED IN and any and all subsidiaries ACCORDANCE WITH THE POLICY PROvtS10NS, Atte:Vendor Insurance PO BOX 1111 AUTHORRED REPRESENTATIVE N Wilkesboro,NC 28656 David C Bruett (rD 1988-2010 ACORD CORPORATION. All rights re Served. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD The Commonwealth o Artassachusetis Department of Industrial Accidents Office of Investigations i 600 Washington Street Boston, ASA 02111 w w w anass.go vIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly INa111e (BusincsslOrp,aoization/htciividual): Me AlQ{V ,address: —7+4l l City/State/Zip: tI fledoy) M 6 0 Pllone #: T-7 8` 7ag•6ra3 Are you an employer? Check the• propriate box: Type of project(required): 1 am a cmplover with 1 4. ❑ I am a �ocoeral contractor and i jhave hired the sub-contractors G. [:1 New construction employees(full and/or part-ti'mc).:'- 2.'❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have ship and have no cmploye�s S. E] Demolition workimg for me in any capacity. employees and have workers' y. ❑ Building addition JNo workers' comp, insurance comp insurance.+ required.1 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 ant a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per�1CiL 12 ❑ Rt.mf repairs insurance required.] c. 152, §10),and we have no employees. [No workers' 13.� r-_�Othet'U me comp. insurance required.] `Antapplicant that cheeks hoz 01 utast also fill out the section helow showing their workers'compcmation police infornmtion. Ih;nwowners whit submit this affidavit indicating they are doing all work:fill then hire outside contractors must suhrnit a new affidavit indicating such. :Contractor<tth:u kit ech tills box must anached an additional sheet showing the name of the sub-contractors anel state whether or not these entities have employees. If the;uh-enntractors have employees,they must pro%iitc their workers'comp,policy number. 1 ant an employer that is providhkq workers'compensation insurance for my employees. Below is the policy and job site histfraoce Company Name: .T. �U Q{ J-Y1 S. Co&Wkn Policy it or self-ins. Lit:. t€: �CC,rjp0'5!7I y �$� a�j _ Expiration Date:— 1 .lob Site Address: �(y. �'et'Yl S'1' _ -- City/State/Zip:.--_Noy 19yQw4 M/s DI Sys 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 NIGL c-. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well ,is civil penalties in the form of it STOP WOI:K ORDER and a fine of up to 5250.00 if clay 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 hereh>v certif tnder the pains and penalties of perlurj,that the information provided above is true and correct. , �;nautrc_ - -- =/ Date: Phone tt: tfflicial use only. Do not write in this area,to he completed by city or town nf�cirrL 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 Contact Pet:son:--------_----- -----____ — Phone out t4 a5sacht�seEts -Eklpart-IMnnt of Public Safety $Uard Of StAilding Regulations and Standards t.;Cense: GS-081074 %%I' Y.1 t% I�r. dbSIPH G MCN fY 767'WODKIRN Sr H WX.LM N(-F{)N IWA Lon+mis.5i 0 116I2p16 .. JT 7-4 N i d 4 S ti r �a ,►nrxcitv ( �f'i;f{tKi�ildr+te�/J v :�.1 OfTtet a)•�Cuaanmer atnilra&Bueineao RtgnlBtEoe ME IMPR0YE) ENT CONMdTQR ! et)Ist�tian: X7756? 7D}� plratlnn:`•1,1b M'b lndlviduat�' ,tt1SLG..MCNAfiY ���,,,,,,,,,,,,333 �,•/ ,108M 1 MCNARY 767 WORURN ST MIXIINGTON,MA 0tag! . . ltodersecretrry ;