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HomeMy WebLinkAboutBuilding Permit # 1/22/2016 IJIL IN PERMIT Notary OF,�.TyED 161 �O TOWN OF NORTH ANDOVER �� 5 ,. . .:_...gib APPLICATION FOR PLAN EXAMINATION » Permit No#: Date Received A �SsacHusE��S Date Issued: �IP�ORTANT: Applicant must complete all items on this page LOCATION - 199 Amo , QA� PmAoyef MAS Print Priqq 1 PROPERTY OWNER °�� SSS PN �4Q, Print 100 Year Structure yes no MAP PARCEL: =' ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other N Se t c ®U1%ell I®od la D et[a cls ® 1Nater ie nc a e>Sewe h DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: �� ?ay) Gbo\�, Phone: �q �l �� r)2 � Email Address: Y 6=�br4f- n-f Unj Zo-EJ146 Gac/ Supervisor's Construction License:--102-965- Exp. Date: ,7�26 Home Improvement License: t60163 _Exp. Date: l Z 3 201 , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: S 0C,>X9O FEE: $ Check No.: Receipt � NOTE: Persons contracting with unregistered co tracto o no ha access to the guaranty fund gehlL „. M_ I NORTH own of O t\Andover o h ver, ass, COC MICNEWICK ��• �ds RATED pPA�.�y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System r� y f BUILDING INSPECTOR THIS CERTIFIES THAT .........!.� . .. . .. � .. G!r....d�. �f fz. .:....................................... rgd O�� �r Foundation has permission to erect.......................... buildings on ................ . ....................................................... Rough ... to be occupied as p' .................... .............. ..... ... . ye�.....�............ ... ............................................. 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 STARTS Rough �j' Service ....... ..... ^�".1t7r 7rr............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. PROPOSAL 4 GREENRRIAR DR. UNIT 207 C©NSTRUCTI�N NORTH READING, MA 01864 GC LIC# 102965, HIC LIC#168163 J NTASARES@HOTMAIL.COM • 0• 11 jeanfabares@hofmaii.com Customer Name: 198 Mass Ave Realty,LLC Address: 198 Massachusetts Avenue City,State: North Andover,MA 01845 1311666#. 178=611-1200 Project title: Handicap Ramp. Date: 1 /18/2016 Item • " Iristallation of a pressure treated`W`odd handicap"' 1 $8;AMO $`81,450.00' ramp. LABOR Installation of a handicap hand rail in the front of the j building *RAMP SHALL MEET ALL ADA&MA BUILDING $ 0.00 CODES. *ASPHALT PAVEMENT WILL NOT BE CUT TO LABOR INSTALL RAMP. DESCRIPTION *OTHERS RESPONSIBLE FOR PARKING AND TRAFFIC ALTERATIONS OR CHANGES. *RAILS SHALL BE METAL ADA&VINIL OUTER RAIL MATERIALS BY CONTRACTOR. 1 $ 0.00 ALLOWANCE "TABARES CONSTRUCTION". GARBAGE REMOVAL OF ALL DEBRIS. 1 $ 0.00 DISPOSAL Subtotal $ 8,450.00 Contractors Fee 10.00% WAIVED Total $ 6,4P0.00 Customer Sigrj�� f-�' a Contractor Sig: a cvi �� a ��e����t r, ,�� kf } t G✓f k� �,P OR r TERMS AND CONDITIONS 1)Scope of work:Contractor agrees to furnish all laborseryices ,rpaterialsJnstallation,supplies, insurance,equipment,tools and other facilities required for prompt,and efficient execut on,of the work described here in a professional and workmanlike manner. 2)Quote Amount: Owner agrees to pay contractor for the strict.performance.of work;the sum as may be subsequently agreed upon. t t, 3)Payment schedule: Owner agrees to pay contractor in progress payment as follows: Payment#10000.00 upon the singing of the estimate t a Payrii¢erit#2%ft 50 00 upon starting day , ` Finaltpaymen t$4;000.0 upon 100%completion puts .any acichtional cost the customer,has already'R agreed on the progres's of the project,"extras". , 4)Work schedule-- contractor shall egmplete the work as,required.by.�Agreementwill ihe,imine owner, contractor is agreed to take no longer then 3 Days from the starting date(01-22-2016)to,complete the work.The parties hereto have execuied this`,-Agrgeinent-for themselves;their heir;executors,successors, administrators,and assignees on theday and year written below. I I � 1 1 s 9 t I J, I Customer Sig: Contractor Sig: The Commonwealth of'.Massmehtlsetts Department of Indr�sfrial�ccrc�ents 1 Congress Street,Suite 100 r Boston,MA 02114-2017 ~' �t www-mass.gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/El�ctrzcians/PXumbexs. TO BE]FILED WITH THE PERMITTING AUTHORITY. Please Paint I,e ibl ATplicant Information Na1'n0 (Business/Oxganization/In.dividnal). ��( .A.ddxess: 6�LCr tiC�Y U City/State/Zip. `C�� � � ®hone#: Are-you an employer?Checkt�lie appropriate box: Type of project(xecluired): 1�I am a employer with__(%= --emPloyces(full and/or part-time).* 7. [J Now construction 2. I am a sole proprietor or partnership and have no employees Working forme in 8. Remo deliiig any capacity.[No workers'comp.insurance required.] 9. Q Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. 1-will compensation insurance or are sole ensure That all contractors either have workers' 11.Q Electrical repairs or additions proprietors with-no employees: 12.F]Plumbing repairs oraddxtlons 5.Q I am a general contractor and l have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.iusurance.1 14 ❑Other 6Q We are a corporation and its of gers have exercised their right of exemption per MGL G. 152,§1(4),and we havo no,employ e s.[No workers'comp.insurance required.] *Any applicant that checksliox#1mustalsofilloutthesectionbclowshowingtheirworkusi econtractorsmu on policy I Homeowners who suliriiitthis affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. tConfractors that check this box must-attachedanadditional sheet at the name of the sub-contractors and stat whether or not those entities have . tractors have employees,they must provide their workers'comp.policy number. employees. If the sub con ' f am an employer that is piovidiizg workers'compensation insurance for my employees.' below is the policy and jo/i site information. insurance Company Name.- policy ame:policy#or Self-ins,Lio.#: Expiration Date: fob Site Address- City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure covexage as required under MGL e.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties inthe form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. f do Xzef eby certify under tlzepains andpenalties ofpeijuan�that the infOYMation provided above is true and correct. .��.r' �/ V Date: Sign ature: Phone#: `� 0 L 33 c,> z—oG Official use only. Do not1Vp1te 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.CitylTown Clerk 4.Fjectrical.inspector 5.plumbing inspector 6.Other Contact Person: Phone#: Office of Consumer Affairs&B smess Regulation HOME IMPROVEMENT CONTRACTOR, Registration:,;,A.68163 Type: a Expiration:- A13/20,17 DBA TA RES CONSTRUCTION ((? JEAN TABARES 4 GREENBRIAR DR{APT207 g ->� NORTH READING MA;018¢4 Undersecretary iZ Massachusetts -Department of Public.. .Safety Board of Building Regulations and Standards Construction Supervisor License: CS-102965 '".� F 5 JEAN TABARE ` 35MGE G1tEEN, North Andover N1[A 0 " r , r s. �y 0%,�..� ,tJ�v[ .''1 1 i Expiration Commissioner 08/23/2016