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Home My WebLink AboutBuilding Permit # 4/19/2016 OORTH BUILDING ..PERMIT gq�eo ,b�'�'� �,"�. hGH.�� T® OF NORTH ANDOVER ;;; ... :..:w.. APPLICATION FOR PLAN EXAMINATION _ [Permit iso#° �' c! Date Received us`��5 Date Issued: PORTANT: Applicant must complete all items on this page tel/ 10 �J LOCATION "" Print PROPERTY OWNER A4P, m � Print 10p Year Structure yes no yes no istrict MAP PARCEL: "—ZONING DISTRICT:c_�_____..IM hinericDShop Village yes. no . TYPE OF IMPROVEMENT PROPOSED USE Non_ Residential Residential — ❑ New Building ❑ One family ❑ Industrial ❑Addition ❑Two or more family ❑ Commercial ❑Alteration No. of units: epair, replacement ElAssessary Bldg [i Others: ❑ Other / r% El Demolition jj �� . , , r r. DESCRIPTION OF WORK ATO BE PERFORMED: p " dentification Tease Type ov rint Clearly Phone: OWNER: Name: C. 61 Address: F ntractor Name: (a i ,� P ane: all: ;� "�dress: . . Supervisor's Construction License: f - Exp. Dater Horne Improvement License: 4 ° ° ° _Exp. Date: ARCHITECT/ENGINEER Phone: Reg. eg. No. FEE SCHEDULE,BULDING PERMIT;$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ )0 0 � 60FEE° $ � Check No.: _Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tothe a a ty fun Z�i lrG/ij/i rrrai r• f `r'.i %i/,� r /� /�/ /r,%.%�rJ/%�'p�;,'.. , f E / /1 a ��' /r ii✓/�iL„//,i,/,,i:.. roil ra rii/�, O"//, l c✓22,�/��>%��f��/// ,/i�r Ui i�/O�rr, :,�.„ „ ,,.. .—. . n,at, �blU»Aj�Ylf� �- NORTH Town '' over p yr 0 ® Imb- C% ver, Mass, Z �� COC LAKa MIC"t WICK 1' / MATED S tI BOARD OF HEALTH r ERMI Food/Kitchen T T D Septic System THIS CERTIFIES THAT . c0 BUILDING INSPECTOR .............. ...................................................................................................... . g ��s Foundation has permission to erect .......................... buildings on ..�...�'�.../" .............�......................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service .•f,��y�""'!"' ...^..�.:c................................ 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. ✓lie -�am�rw�uuP,rzl� o '�/�ilaaaalzuaeC�a ,i Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration: '153188 Type: Expiration: 11/612016 Private Corporatioi r a' B& RESTORATION AND CONTf2ACTING INC PAUL BRUNO 218 PARIS STREET' BAST BOSTON,MA02128 s ,r Undersecretary , rY Massachusetts Department of Public Safety Board of Building Regulations and Standards License: C8-065281 Construction Supervisor 6" PAUL BRUNO „ 109 CHESTNUT STF�E LYNNFIELD MA-'big � b R Expiration: ' Commissioner 09/28/2017 B&MRESTORATIONAAD CONTRACTING, INC. 218 PARIS STREET EAST BOS'T'ON, NIA. 02128 (617) 561-9998 (781) 342-5178 fax (617) 293-1722 cell PROPOSAL AIMCO 2 Greenwood Square 3331 Street Road, Ste 450 Bensalem, PA. 19020 JOB LOCATION: Royal Crest Estates, 19 Royal Crest Drive,N.Andover,MA. WE PROPOSE THE FOLLOWING: Work to be performed on Buildings: 1 Set up protection around the work area. Install safety fence around perimeter of work. Replace brick as needed. After flashing is completed,cut and point building 100%. Building 1: $50,000.00 We hereby propose to furnish all labor and material complete in accordance with the above specifications for the sums stated above. AUTHORIZED SIGNATUREG� DATE: 4-11-2016 Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. AUTHORIZED SIGNATURE f'.,,,,. s !�� DATE: LlG l `, The Commonwealth ofMassa chusefis Department of IndustrialAccidentv I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Li lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTRORITY. Ap-plicant InformationPlease Print ibl Name (Btisiness/OrganizationAndividtia 1 1): LT��11 Address: r City/State/Zip: a () , t-) Phone#: eT) 5' Are you an employer?Check the appir"opriate box; Type of project(Tqquired). I.F]lam aemployerwith.—, employees(full and/or part-time).* 7. F1 Now construction Z[]I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.F1 I am a homeowner doing all work myself[No workers'comp.insurance required.]f 10 h Building addition 4.F]I am ahomeowner and will be hiring contractors to conduct all work onmy 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.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ihesb siib-contrac'torsWe employees and have workers'I comp.insuranceJ 14 I F1 Roof repairs 6.E]We area corporation and its•officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no.p loy es.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submif this affidavit indicating they are doing all work and then hire outside contractors inust submit a new affidavit indicating such. tContractors that checkthis box mustattachedan additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors fiav'p!employees,they must provide their workers'comp.policy number.' fain an employer'drat ispiapidiiigworlceis'compensation insurance for my empl6yees.*Belo1v is'thepollcy and)obsite information. Insurance Company Name: 0 4 h 0 a C V", Policy#or Self-ins,Lie. 4 /V 91011 17 6 171-9 Expiration Date.- '2, '111 fob Site Address: o �'1411 abe I a City/State/Zip: A kA_� z Attach a copy of theworkere compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder 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. Ido hereby certyy-Und, I the pains and penalties ofpeijuiy that the information provided above is true and correct. 2 ? Sig aturo: at," Date: Phone ff: Official use only. Do not write in this area,to he 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#: