HomeMy WebLinkAboutBuilding Permit # 5/11/2016 �raRT
BUILDING PERMIT ED
TOWN OF NORTH ANDOVER
0
APPLICATION FOR PLAN EXAMINATION ,
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Permit No#: Date Received
`1A
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Date Issued:
IMPORTANT: Applicant must complete all,items,on this page
LOCATION (,) JV1( ,Q,,V1, bCAJe,
2
PROPERTY OWNER Printc,
Print '100 Year Structure yes no
MAPC. PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
ri New Building El One family
El Addition Li Two or more family El Industrial
KAlteration No. of units: 11 Commercial
El Repair, replacement 11 Assessory Bldg El Others:
El Demolition El Other
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DESCRIPTION OF WORK TO BE PERFORMED.
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Identification- Please Type or Print Clearly oq
OWNER: Name: Phone:
Address:
f C.,( V a V
21:2
Contractor Name: Phone:
Email: L,V(x, (D A .
Address: 11 01A
Supervisor's Construction License:
Home improvement License: Ex p. ate
SJ e,,ocf)rcd 0 one:
ARCHITECT/ENGINEER t\,)IA - rio
Address: Re. No:
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FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTI MA Ta Cosrmsm 0m,,$125.00 PER S.F.
-.$
Total Project Cost: $ FEE
Check No.: Recoipt,
NOTE: Persons contracting with unregistered contractors(to Ixot have access4a,the guaranty ind
NORTH
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No. ® 2� - -
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��aS RATED
UBOARD OF HEALTH
Food/Kitchen vERMIT Lumlmmsh'
Septic System
..
THIS CERTIFIES THAT °`C,,`7—. BUILDING INSPECTOR
.............................................. ..�.............................. ......................................
IFoundation
has permission to erect ........................... buildings on �U..............................
/ • Rough
to be occupied as ..............&M.49 �6 !... ................................................................. 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
PERMITEXPIRESMONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION RTS Rough
Service
........................ ....................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy Buildin 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 Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
Robert Welch
132 Duncan Dr.
N.Andover MA 01845
To: Peter Vanderweil, Hybrid Construction&Development
RE: Kitchen Remodel
Peter,
Please accept this letter as official contract agreement regarding our kitchen remodeling work at 132
Duncan Drive. Scope includes installing new cabinets and general lighting per our walk through on
4/15/16. Price is not to exceed$9,416 per our current scope and pricing.
Scope Agreement:
• Installing new IKEA cabinets per parts list order#9169-1071.
• Installing(2) pendant fixtures, (5) recessed lights,and one new chandelier fixture
• Patch walls and ceilings as needed-ready for paint. Paint by owner.
We look forward to working with you on this project
Best,
Robert Welch
The Commonwealth of Massachusetts
x Department of IndustrialAccidents
1 Congress Street,Suite 100
"= F' Boston,AM 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Elee,tricians/Plumbers,
TO BE PILED WITH THE PERMITTING AUTHORITY.
Applicant Information [f � IR
t Please Print Legibly
Name(Business/Organization/ludividual): ¢,' r C:1 t" T"t r 6'r 3 (w.t `
Address
City/State/Zip: Phone#: G 7 5"'?
Are you an employer?Oteek tfie appropriate box; Type Of project(1'CClllired):
1.❑1 am a employerwith employees(full and/or part-time).* 7• ❑New constiuction
21 am a sole proprietor or partnership and have no employees working for me in S. MAemodeling
any capacity,[No workers'comp.insurance required.]
t 9. Demolition
3.❑lain a homeowner doing all work myself[No worlcers'comp..insurance required.]
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. Phnnbing repairs or additions
5. I arn,a general contractor and I have lured the sub-contractors listed on the attached sheet.
❑ 13. Roof repairs
These sub-contractors have employees and have workers'comp,insurance.1
6•❑We are a corporation and its,officers have exercised their right of exemption per MGL c, 14.F1 Other
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 submif this affidavit indicating they are doing all work and then hire outside contractors ihust 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 fiave employees,they must provide their workers'comp.policy number.
X am an employer that is pi'ovidhig worlcerscompensation insurance for my employees.'Below is the policy andjob site
information.
Insurance Company Name;
Policy#or Self-ins,Lie.#: Expiration Date:
Job Site Address
.. VX�eNJ('&rJ C 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 WORD.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.
X do hereby certify ct#der the pains andpenalties of per jury that the information provided above is true and correct.
Sign re: " Date: / {
Phone#: ! �- C7,
... �:
Official use only. Do not write in this area,to be completed by city or tolyl 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#:
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CERTIFICATE OF LIABIUTY INSURANCE
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EMUMSIONS AN:D CONDITION x OF SUCHk PQL1CIES.LIVIRSs SHiC;llldN MAY HAVE BEEN REQIiCM BY PAID CLA[tf/&
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Massachusetts - Department of Pubic Safety
Board of Building Regulations and Standards
' LU11)ll Ul.11 Ull Jtl�)L'11191/1
License: CS-085720
1 PETER L VANDEJtWE. �;�
29 EDGEWATERrTtD< �
�Mu1T MA 02045
Expiration
12/17/2016
Commissioner
J ,
��e °iJz77uarzcee"'1111 a,
Office of Consumer Affais&
HO
I Busine
ME IMPROVEMENT CONTRACTOR
ss RegulatioJn
Registration 169530
f 11 >r1' Expiration: .5/17/2018 LLC Type:
HYBRID CONSTRUCTION&;DEVE 'OP I
O MENT, LLC.
PETER VANDERWEIL
29 EDGEWATER RD.'--
H
ULL,
D.HULL,MA 02045 l _
Undersecretary y