Loading...
HomeMy WebLinkAboutBuilding Permit # 3/28/2016 UILDING PERMIT OcgH o �44&.D lR "V TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Date Received pp°� npa `a Permit I\lo#: ArED�sS cwuS��� 17 Date Issued: Im ORTANT: Applicant must complete all items on this page LOCATION 1,"f( .°' Print PROPERTY OWNER �70aAa °° Print 100 Year Structure yesno : MAP PARCEL: I ZONING DISTRICTHistoric District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Nan- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Er/Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other / f , /., DESCRIPTION OF WORK TO BE PERFORMED: at oU 92L Identification- Please Type or Print Clearly OWNER' Name: I Phone: ), 52, Address: o(, Contractor Name: 4,,14" 1 , Phone: „ Email' 5 Si I k.i i Z L A,& Address: w Supervisor's Construction License: 6-5- 609 Exp. Date: I, i I' - Z- I Home Improvement License: I 1 �. Ex I ` "" p. Date: 1 - 2, ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12,00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ > ���:�0 0 FEE: $ , � .� Check No.: r Receipt No.: ? � " ' NOTE: Persons contracting with unregistered contra c ,not have ecce naranty fiend tjORT1y Town of An.dover _ '. ® ® 4 z _ n h ver, Mass, / O LAN! a COC NIC NE W.CK A0RATEO BOARD OF HEALTH Food/Kitchen PrMRMIT T %W LD Septic System i THIS CERTIFIES THAT .........win . .. ,vG„ ......... BUILDING INSPECTOR . ...................................................................... /® Foundation has permission to erect .......................... buildings on ............. ..... l� '© ....................................... Rough to be occupied as ......................i�. 6® . � .. t .. ......11?. .;.,/�1� (..'....................................... Chimney provided that the person accepting this permit shall In every respect con orm 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 .......'.. Service ................. .... .may ..r.r. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BulldlnRough 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. Stephen Silk Renovation & Restoration North Andover, MA 01845 MA License # CS-098533 HIC License # 176182 (978)886-0447 INSURANCE CLAIM: To: Susan Lucy Re: 100 Mill Pond North Andover, MA Date: March 24, 2016 SCOPE OF SERVICES: • Insulate bedroom ceiling @ outside perimeter rim joist & outside sill using foam batt insulation as needed / per code • Insulate any exposed pipes with Armor flex pipe insulation (accessible pipes only) • Replace drywall removed during remediation throughout, finish with joint compound to match existing wall finish • Install 5/8 fire code drywall as needed per code • Prime & paint all areas affected by remediation walls, ceiling, & trim. Stain kill as needed • Install new 3 1/2 colonial baseboard, 2 1/2 colonial door casing removed during remediation • Install closet shelving, heavy duty chrome closet poles @ 2 bedroom closets • Install 2 fluorescent fixtures with lens @ bedroom closet • Final cleaning ® Total Construction Costs: $3000.00 Payment Schedule: $1000.00- Deposit $2000.00- At completion of work Terms and Conditions • Contractor agrees to furnish all necessary labor, tools, equipment and materials to complete the work outlined in the scope of services. • Contractor shall provide copies of a valid builder's license and proof of liability and worker's compensation insurance prior to commencement of any work. • Contractor agrees to complete the Scope of Services in a timely and professional manner in accordance with the specifications set forth by the architect and engineers, and in compliance with state and local building regulations. • Contractor agrees to clean all debris from construction only and to keep the job site in a clean and workable condition at all times. • Any materials, products or labor not specifically mentioned in scope of services is not covered under contract and will be paid for out of allowance fund or billed to homeowner (monies denoted in bold next to categories are included in overall price and will be drawn from to pay for materials and installations) • Homeowner (not lender) is ultimately responsible for payment upon completion of services and receipt of invoices. • Anything not specifically mentioned in above scope of services will be billed at $65 per hour, plus materials. • All materials/labor supplied by Silk Renovation/Restoration are warrantee for lyear from date of completion. (LA, , _ Susan Lucy Date Stephen Silk Date The Commonwealth of Massachusetts Department oflndustrialAccidents d I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lep-ibly Name (Business/Organization4ndividual): 4- '9LL—fG Address: ' City/State/Zip: Phone#: c 7 Are you an employer?Check the appropriate box: Type of project(required): 1, m a employer with employees(full and/or part-time).* 7. ❑New construction 2.6 1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.VrOther if Pe#,�. 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who snbriiif this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors 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. I am an employer that is providing workersI compensation insurance for•my employees.'Below is the policy and job site information. Insurance Company Name: f P-t--V>r�I1 Policy#or Self-ins,Lie.#: Expiration Date: Job Site Address: l:;6 Ni v— City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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 in the 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 DIA for insurance coverage verification. I do hereby certify under thepains apfpenalties ofperjury that the information provided above is true and correct. Si nature: n Date: "3 - 2 Y c L Phone#• 1 -� 1- ` Q O`t`'f 7 Official use only. Do not rvrite 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 Contact Person: Phone#: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-098533 Construction Supervisor ? STEPHEN A SILK �� 33 PERLEY ROAD NORTH ANDOVER MA 01845 Expiration: Commissioner 11/1312017 F C'��e l('OII!/ItDIICC/RCf!/l�C���'/�"ClJurlC.'�CCJCI�J Office of consumer Affairs&Business Regulation T DOME IMPROVEMENT CONTRACTOR Type: egistration: 176182 f xpiration: 7/25/2015 DBA STEPHEN SILK RENOVATION&RESTORATION STEPHEN SILK 33 PERLEY RD NO.ANDOVER,MA 01845 Undersecretary