HomeMy WebLinkAboutBuilding Permit # 3/7/2016 _l
BUILDING PERMIT �aoo-avyIq
TOWN OF NORTH ANDOVER ®
APPLICATION FOR PLAN EXAMINATION.:. 0
Permit No#: Date ReceivedAreo
�SSACHUS��°L
Date Issued:
RT't NT: Applicant must complete all items on this page
LOCATION (\
1� Pri
PROPERTY OWNER ba��u
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED QSE
Residential Non- Residential
❑ New Building kone family
❑Addition ❑Two or more family ❑ Industrial
KAlteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
Demolition ❑ Other
}rSt crr [fl `r r`❑ Flood r lain ❑Wetlands ,❑ atersted District
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DESCRIPTION F OR TO DE PERORMED'
('J J
Identification`Plea e'Type or Print Clearly
OWNER: Name: t Phone: ��
Address:
Contractor Na Phone:
Email
Address:
Supervisor's Construction License: (�5 "b V'' Exp. Date: d
Home Improvement License: Exp. Date: Ld
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT.•$92,00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ � FEE: $
N
Check No.: Receipt No.: 30 0
NOTE: .persons contracting with unregistered contractors do not have access to oars ty fular�
L
NORTH
own oAndover
.�.�. 0
261� �( LAKE ver, ass,
T O
COCMICHEMIICK
ADRATED
S U
BOARD OF HEALTH
Food/Kitchen
Septic System
PERMIT L �D00011, •
THIS CERTIFIES THAT .................................... .. .. .. BUILDING INSPECTOR
...... ............... ...................................
has permission to erect ....................... buildings on ..........'' .... ....... ..... .....h .
Foundation
............................................... Rough
t0 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
y
PERMITEXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
LESS CONSTRUCTIO T S Rough
Service
,411
.................. . ...................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Oeeupaney Permit Required to Oeeupy Buildin„r; Rough
Al
Display in a Conspicuous Place on the Premises — Do Not Remove Final
o Lathing o al To Be Done FIRE DEPARTMENT
ntil InspectsUd and Approvedthe Building Inspector.
Burner
Street No.
Smoke Det.
_ z
Trepanier Remodeling LLC HIC#122347
14 East Capitol Street
Methuen, MA 01844 CS#069815 Date Estimate#
7/18/2015 3
Name/Address
Ray Tudisco
74 Meadow Ln
No.Anodover Ma
Project
Item Description Rate Qty Total
Down stairs bathroom:
Materials/Labor Demo bath to studs and rough and finish of new bath fan/light,GFI,firm up framing complete 5,000.00 5,000.00
firestop to code,install blueboard and plaster,install finish trim,one tower cabinet tile floor
and paint walls and trim:
Upstairs bathroom:
Materials/Labor Demo complete bath,rough and finish of new fan/light GFI and medicine light,firm frame 11,695.00 11,695.00
and firestop and insulate,blueboard and plaster walls,install finish trim,install sublooring
with tile floor and paint bathroom:
01 Plans and Perm... Approximate cost of permit: 200.00 200.00
"Customer to supply fixtures"
"20yd dumpster will be on site for demo and waste from project"
ti
We look forward to working with you!
Total $16,895.00
Jhe Coinmonwealth of Massachusetts
Department of fndus�trlalAccidents
_ X Congress Street,Suite 100
M
o2114 20X7
Boston,m
www.mass.govIdla
o^M Syf�c
_W'Olhers'Compensation
Insure WITHfTHEt:Buff kTIl�TG AUTHOBI�"St ricians/Plunabers.
JULEDPlease Print Lep'bI
ApWicantlnformation
Na1ne (Business/Organizatxonllndivi(ival):
Address:
���{ hone
City/State/Zip: 0 � • ., .:.
[Areyou an employer?Chetlie appxopxiatehox: 'Type oftproject(required);
employees(frill and/or part time).* ry,lamaemployerwith_ 8. emodelli g
�l am a sole proprietor or partnership and have no employees Working for me in Demolition
ny capacity.[No workers'comp.insurance required.] 9
3-0 l am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 Building addition
4.❑l am a homeowner and will be hiring contractors to conduct all work on my property. l will 11❑Electrical repairs or additions
ensure that all contractors either have workers'compensation insurance or are sole 12 4
Q)?Xum-bing repairs or additions
proprietors withno employees.
5.❑T am a general contractor and lhave hiredthesub-contractors listed orthe attached sheet.
13•.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.$ 14.Q Other
6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c.
152,
§1(4).and ire have no empldyees:[No workers'comp.insurance required.]
Any applicant that check's box#1 must alsarfill out hheYsaec abelowoinall work and then hire outside contractors compensation
om st submit aan w affidavit indicating such.
i Homeowners who submit•thi,s afdavrt m g
tContractors that check this box must attached
employees,henadditional they mussheet showing t pr vide heirtwor kers'cotmp sub-contractors
number.and state whether or not(hose entities have
employees. If the sub-cdn6ctorshav
X am an employer that isproviding-workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Expiration Date.
policy#or Self-ins.Lic.#:
City/State/Zip:
rob Site Address: showing the policy number and expiration date).
Attach a copy of the workers' compensation policy declaration page(
olation punishable by a fulb up to 500.00
Failure to Secure coverage as requited under MOL penalties in the form of a TOPal rWOR ORDER and a fine of up to $250.00 a
and/or one-year imprisonment,as well as civil p
be forwarded to the Office of Investigations of the DIA for Insurance
day against the violator.A copy of flus statement may
coverage verification.
X do hereby ce tz u r'tliepains andpenalties ofperjury that the information provided Bove i true and correct
Date:
Si afore:
Phone#: �l
Official use only. Do not Write
in this area,to be completed by city or town official.
PermiULicense#
City or Town:
Issuing Authority(circle one): '
1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Phone#-
Contact Person:
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
__.__.
'i �uu�u uc'&i0n 51pZi v1S0i
License: CS-069815
Robert W Trepanig%Jr -" f
14 East Capitol StfeetRi
Methuen MA 01944 r,
�r➢�;�` Expiration
914—
Commissioner
09/23/2016
• �ie����a�ccuea��z d��l���
Office of Consumer Affairs&BusmessTkctrahy��5
HOME IMPROVEMENT CONTRACTOR taper`
a
Reg!strat➢on 122347 DBA ,
Expirat➢on
312012016
TREPANIERTILE&'REIjIIODELIN
ROBERT TREPANIER JR
-14 E.CAPITOL ST. - —"
MA 01844 t)ndersecietary• i
METHUEN,,